Epidemiology, risk factors, maternal and perinatal outcomes of uterine rupture: a 7-year retrospective study from a Moroccan tertiary hospital.

Abstract

Background: Uterine rupture (UR) is a rare but life-threatening obstetric emergency associated with high maternal and perinatal morbidity and mortality, particularly in low-resource settings. Delayed diagnosis and management significantly worsen outcomes. This study aimed to describe the epidemiological characteristics, risk factors, management, and maternal and perinatal outcomes of uterine rupture, with particular emphasis on distinguishing neglected from non-neglected cases.

Methods: A retrospective descriptive study was conducted at Mohammed VI University Hospital, Marrakesh, Morocco, between January 2017 and December 2024. All confirmed cases of uterine rupture were included. Demographic, obstetric, clinical, and surgical data were collected from medical records. Maternal and perinatal outcomes were compared according to uterine scar status and delay in management.

Results: Among 115,121 deliveries, 74 cases of uterine rupture were identified, corresponding to an incidence of 0.06%. Rupture occurred in unscarred uteri in 57% of cases and in scarred uteri in 43%. Inadequate or absent antenatal care was reported in 81% of patients. Hysterectomy was required in 23% of cases, predominantly in neglected ruptures. Maternal mortality was 1.4%, while perinatal mortality reached 35.1%, occurring mainly in neglected and unscarred uterine ruptures.

Conclusion: Uterine rupture remains a severe and largely preventable obstetric emergency in low-resource settings. Strengthening antenatal care, eliminating harmful obstetric practices, and ensuring timely referrals and intervention are essential to reduce preventable morbidity and mortality.