Rupture utérine à l’Hôpital Général de Douala: prévalence, facteurs associés, prise en charge et pronostic

ESUME BUT. l’objectif etait d’evaluer la prevalence, les facteurs associes, le traitement et le pronostic des ruptures uterines. MATERIELS ET METHODES : Il s’agissait d’une etude transversale sur 10 ans. Tous les dossiers des patientes prises en charge pour rupture uterine etaient inclus. Les donnees recueillies etaient sociodemographiques, cliniques, therapeutiques et pronostiques. Les donnees etaient analysees par Microsoft Excel et EPI INFO7. Les statistiques etaient descriptives et analytiques. Nous avons notamment evalue par les tests de Khi-deux et de Student, les facteurs associes a la survie fœtale. Le seuil de significativite p a ete fixe a 5%. La clearance ethique a ete obtenue et les donnee traitees dans le strict respect de la confidentialite. RESULTATS. La prevalence des ruptures uterines etait de 0,40%. Les facteurs associes etaient l’âge maternel eleve (81%); l’utilisation du Misoprostol (71.9%), les antecedents de curetage (50%) et les antecedents de cesarienne (37%). Le traitement conservateur etait le plus pratique (84,4%). La mortalite maternelle et fœtale etait respectivement de 6% et 66%. Les facteurs de bon pronostic de survie fœtale etaient le delai reduit entre le diagnostic et la prise en charge (p= 0,007), une moyenne du poids fœtal plus elevee (p=0.002). CONCLUSION. La rupture uterine semble rare ; elle serait surtout liee a l’utilisation du Misoprostol. Le traitement est surtout conservateur avec une survie fœtale amelioree. L’utilisation rationnelle du Misoprostol pourrait reduire la frequence de cette affection dans le service. ABSTRACT OBJECTIVES. The aim was to evaluate the prevalence, associated factors, treatment and prognosis of uterine rupture. MATERIALS AND METHODS. It was a cross sectional study over a period of 10 years. All files of patients with uterine rupture were included. Data was collected on socio-demographic characteristics, clinical presentation, therapeutic measures and prognostic factors. The data were analyzed using Microsoft Excel and EPI INFO7; the statistics were descriptive and analytical. We evaluated by chi-square test and Student test, factors associated to fetal survival. The probability p was considered significant if u003c 5%. The study was conducted after obtaining ethical clearance, with respect of confidentiality of data. RESULTS. The prevalence of uterine rupture was 0.40 %. Factors associated to uterine ruptures were advanced maternal age (81%); the use of misoprostol (71.9 %), history of dilatation and curettage (50 %) and a past history of cesarean section (37%). The treatment was mainly conservative (84,4%). Maternal and fetal mortality was 6% and 66 % respectively. The favorable prognosis factors of fetal survival were the reduced time between diagnosis and the treatment (p = 0.007), high fetal weight (p = 0.002) CONCLUSION. Uterine rupture seems to be rare in our service; it may be related to the use of misoprostol. Treatment is mostly conservative with amelioration of fetal survival. Proper use of misoprostol can reduce the frequency of this condition in the service.