Table 6 Reasons why obstetricians think that conservative surgery (uterine repair alone), N = 28, or sterilising surgeries (any of uterine repair with bilateral tubal ligation, subtotal hysterectomy and total abdominal hysterectomy), N = 41, should be adopted as standard surgery for managing uterine rupture
From: Evaluation of obstetricians’ surgical decision making in the management of uterine rupture
Reasons | N (%) |
|---|---|
Uterine repair alone (conservative surgical option) | 28 (100.00) |
Infant mortality rate is high | 23 (82.1) |
Cultural significance of childbearing in marriage stabilisation | 21 (75.0) |
Use contraception to prevent further pregnancies if deemed risky and undesired | 17 (60.7) |
Counsel women with low parity properly | 15 (53.6) |
Literate mothers with low parity can be allowed to expand their families’ sizes | 13 (46.4) |
Circumstances of uterine rupture vary, so individualise treatment | 13 (46.4) |
Our people cherish their ability to reproduce | 13 (46.4) |
Infertility is a major cause of family strife | 11 (39.3) |
Counselling/informed consent should determine a woman’s assent to sterilisation | 9 (32.1) |
Preferred sex of babies may not have been achieved | 8 (28.6) |
Woman may be of low parity and desire more children | 7 (25.0) |
Ruptured uterus not likely to occur if subsequent pregnancies are well managed | 7 (25.0) |
Assisted reproduction is very costly | 4 (14.3) |
Because surrogacy and adoption are poorly established | 3 (10.7) |
Sterilising surgical options | 41 (100.0) |
Poverty | 37 (90.2) |
Low educational status of patients | 37 (90.2) |
Poor health-seeking behaviour and no antenatal care in pregnancy | 35 (85.4) |
High fertility rate, high mean parity and low contraceptive uptake | 33 (80.5) |
Very high recurrence rate | 29 (70.7) |
There may not be an appropriate hospital in her community | 27 (65.9) |
Most of the patients are in a bad state at presentation | 27 (65.9) |
Available hospitals may be in great disrepair | 26 (63.4) |
Poor access to tertiary hospitals and very high cost of care | 26 (63.4) |
Poor blood banking facilities | 23 (56.1) |
To remove the risk of recurrence and prevent death in future pregnancies | 21 (51.2) |
To prevent delay in presentation and management in subsequent pregnancy | 19 (46.3) |
Loss of faith in hospital services | 17 (41.5) |
To keep her alive | 17 (41.5) |
Other reproductive options such as surrogacy and adoption are available | 9 (22.0) |
Wounded womb is not very good for reproductive career | 5 (12.2) |