Uterine rupture stands as a single obstetric accident that exposes the flaws and inequities of health systems and the society at large due to the degree of neglect that it entails . It is a common obstetric complication in low income countries [2, 3]. And affected mothers and their unborn babies suffer grievous outcomes, hence the various terms used to qualify uterine rupture in the literature [3,4,5,6,7,8,9]. The major predisposing factors are poverty, ignorance, illiteracy, traditional practices, high parity, poor infrastructure, cephalopelvic disproportion, previous uterine scars and poor obstetric care [1, 2, 4,5,6,7]. Poor obstetric care comprises lack of antenatal care, having unsupervised deliveries outside of health facilities, injudicious use of oxytocics to facilitate labour, and the resultant obstructed labour. All these factors abound in low income countries and make uterine rupture a commoner complication of pregnancy and labour compared to high income countries where uterine rupture very rarely complicates labour and the major risk factor is previous cesarean scar [2,3,4, 9, 10].
In Nigeria, uterine rupture is a frequent obstetric complication and reported incidence rates vary from 1 in 81 to 1 in 426 deliveries [2, 4, 5, 11,12,13,14,15,16,17,18,19,20]. These rates are largely similar to rates from sub-Saharan African countries like Ghana , Ethiopia [21, 22], Uganda  and Sudan , but generally higher than the rate of 1 in 445 deliveries from Tanzania . Some studies show that most cases of uterine rupture occur outside the hospital. These consist of the 59 to 85% of women suffering uterine rupture who did not register for antenatal care (unbooked) [2, 4, 5, 12, 14,15,16,17,18,19] plus the proportion that registered for antenatal care (booked) but embarked on delivery outside the hospital and only return after the rupture had occurred. On the contrary, other studies show that greater than 55% of ruptures occur after the woman was admitted into a health facility [6, 26], highlighting the role of third delays in uterine rupture. Uterine rupture is often associated with high maternal and perinatal mortalities with reported maternal case fatality rates of 5.9 to 21.3% and perinatal mortality rates of 75.4 to 98.6% [2, 4, 5, 11,12,13,14,15,16,17,18, 20]. Maternal and perinatal morbidities are similarly high among survivors. Uterine dehiscence, uterine “windows” and occult or incomplete ruptures describe the partial separation of the uterine wall with intact overlying serosa [8, 16]. They are not often included as cases of uterine rupture because they seldom result in major maternal and fetal complications [16, 27].
Once a diagnosis of uterine rupture is made, surgery is the principal mode of management. The surgery often adopted is the quickest procedure that proves to be life-saving . Available methods either conserve reproduction (uterine repair alone) or sterilise the patient (uterine repair with bilateral tubal ligation, subtotal hysterectomy or total abdominal hysterectomy) [1, 2, 4,5,6,7, 10,11,12,13,14,15,16,17,18,19,20,21, 28]. Preservation of the woman’s ability to reproduce by uterine repair alone leaves her with a uterine scar that has a higher risk of repeat rupture in future pregnancies [10, 17]. On the other hand, sterilisation by any of the other three surgical options makes the woman vulnerable to certain psychosocial complications linked to infertility, including marital disharmony [2, 5, 21]. Uterine rupture is the commonest indication for inevitable peripartum hysterectomy in Nigeria . Despite these, there is wide variation in the frequency of use of the different surgical methods in managing uterine rupture in different centres and settings at different times both in Nigeria [2, 4, 5, 11, 12, 14,15,16,17,18,19,20] and other low income countries of sub-Saharan Africa [1, 6, 21,22,23,24,25] and in Asia [7, 13, 27, 30,31,32]. Thus, literature does not appear to favour any particular surgical method over the others. In fact, literature seems to suggest that the existing data are insufficient to advocate for any specific surgical method as the standard surgical management for uterine rupture . But expectedly, obstetricians who are at the forefront in managing uterine rupture should have experiences to share. Hence, we deemed it pertinent to assess obstetricians’ overviews of surgical management of uterine rupture with a view to determine factors that guide their surgical decision making and evaluate their uses of, and experiences with as well as opinions about conserving and sterilising surgical methods.
The aims of this study are, therefore, to evaluate Nigerian obstetricians’ experiences with the surgical management of uterine rupture and their perspectives on the surgical management methods. A literature search did not find any similar study from Nigeria and/or elsewhere.