Prevalence and determinants of uterine rupture in Ethiopia: a systematic review and meta-analysis

Scientific Reports, Volume 10, No. 1, Year 2020

Interpretação

Uterine rupture is a serious public health concern that causes high maternal and perinatal morbidity and mortality in the developing world. Few of the studies conducted in Ethiopia show a high discrepancy in the prevalence of uterine rupture, which ranges between 1.6 and 16.7%. There also lacks a national study on this issue in Ethiopia. This systematic and meta-analysis, therefore, was conducted to assess the prevalence and determinants of uterine rupture in Ethiopia. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic review and meta-analysis of studies. All observational published studies were retrieved using relevant search terms in Google scholar, African Journals Online, CINHAL, HINARI, Science Direct, Cochrane Library, EMBASE and PubMed (Medline) databases. Newcastle–Ottawa assessment checklist for observational studies was used for critical appraisal of the included articles. The meta-analysis was done with STATA version 14 software. The I2 test statistics were used to assess heterogeneity among included studies, and publication bias was assessed using Begg’s and Egger’s tests. Odds ratio (OR) with a 95% confidence interval (CI) was presented using forest plots. A total of twelve studies were included in this study. The pooled prevalence of uterine rupture was 3.98% (95% CI 3.02, 4.95). The highest (7.82%) and lowest (1.53%) prevalence were identified in Amhara and Southern Nations, Nationality and Peoples Region (SNNPR), respectively. Determinants of uterine rupture were urban residence (OR = 0.15 (95% CI 0.09, 0.23)), primipara (OR = 0.12 (95% CI 0.06, 0.27)), previous cesarean section (OR = 3.23 (95% CI 2.12, 4.92)), obstructed labor(OR = 12.21 (95% CI 6.01, 24.82)), and partograph utilization (OR = 0.12 (95% CI 0.09, 0.17)). Almost one in twenty-five mothers had uterine rupture in Ethiopia. Urban residence, primiparity, previous cesarean section, obstructed labor and partograph utilization were significantly associated with uterine rupture. Therefore, intervention programs should address the identified factors to reduce the prevalence of uterine rupture. We conducted this systematic review and meta-analysis of all observational published studies to assess the pooled prevalence and determinants of uterine rupture in Ethiopia. Retrieving of the included studies was done in different databases such as Google scholar, African Journals Online, CINHAL, HINARI, Science Direct, Cochrane Library, EMBASE and PubMed (Medline) without restricting the study period. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline was strictly followed during systematic review and meta-analysis31. A combination of search terms that best describe the study variables were used to retrieve articles. These include risk factors, determinants, predictors, factors, magnitude, prevalence, incidence, uterine rupture, laparotomy, hysterectomy, and Ethiopia. The terms were combined using “OR’ and “AND” Boolean operators. Additionally, reference list of the already identified articles were checked to find additional eligible articles but were missed during the initial searching. Study design All observational studies were included. Study period Studies conducted until August 2018 were included. Participants Women who had given birth at least once before data collection period of the included studies. Language Only articles written in English language were included. Publication status All studies regardless of publication status were considered. Studies which we couldn’t access texts after three emails to the cross ponding authors were excluded. Prevalence uterine rupture was the main outcome of this systematic review and meta-analysis. The pooled prevalence of uterine rupture was determined considering studies in which the status of uterus after delivery was reported. Additionally, determinants of uterine rupture among mothers were the outcome of this study. Data for this study were extracted from the included articles using data extraction checklist. Data extraction was made using Microsoft Excel sheet. Two of the authors (AAA and LBZ) participated in extracting data from the included studies. The data extraction checklist contains variables like author name, publication year, study design, sample size, and exposure characteristics that included the prevalence, partograph utilization, augmentation, residence, obstructed labor, previous Caesarean section (C/S) and antenatal care visit (ANC). An intensive assessment of all articles included in this study was done by the two authors (AAA, MSB, KAG and LBZ). Newcastle–Ottawa assessment checklist32 for observational studies was used to assess the quality of each study included in this research. The tool has three sections. The first section was on methodological assessment and rated out of five stars, and the second section was on comparability evaluation and was rated out of three stars. The third section of the quality assessment tool was on assessing statistical analysis and outcome for each included study. There was a joint discussion between the authors for uncertainty, and the mean quality score was used to decide the quality of the included studies in the meta-analysis. Finally, studies scored ≥ 6 were grouped as having high quality. Important data extracted from each primary (original) study through Microsoft Excel were exported to STATA version 14 software for analysis. Then, standard for each included studies was computed using Binomial distribution formula. To determine the pooled estimate metan STATA command was computed considering random-effect model. Forest plots with 95% confidence interval (CI) were used to present the findings of the study. The weight of each study is described by the size of each box, whereas the crossed line shows the CI at 95%. Publication bias was also assessed using Egger’s and Begg’s tests, and a p-value of less than 0.05 was used to declare its statistical significance33,34. Due to the presence of heterogeneity among33, subgroup analysis was computed considering the geographical region in which the studies were conducted.

AI Digest

Study Justification:

– Uterine rupture is a serious public health concern in the developing world, causing high maternal and perinatal morbidity and mortality.
– There is a lack of national studies on uterine rupture in Ethiopia.
– Previous studies in Ethiopia have shown a wide range in the prevalence of uterine rupture, highlighting the need for a systematic review and meta-analysis to assess the true prevalence and determinants.

Study Highlights:

– The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
– Twelve observational studies were included in the analysis.
– The pooled prevalence of uterine rupture in Ethiopia was found to be 3.98%.
– The highest prevalence was found in the Amhara region (7.82%), while the lowest prevalence was found in the Southern Nations, Nationality and Peoples Region (SNNPR) (1.53%).
– Urban residence, primiparity, previous cesarean section, obstructed labor, and partograph utilization were identified as significant determinants of uterine rupture.

Recommendations for Lay Reader and Policy Maker:

– Intervention programs should be implemented to address the identified determinants of uterine rupture in Ethiopia.
– Strategies should focus on improving access to quality antenatal care, promoting partograph utilization, and ensuring appropriate management of labor, especially in urban areas.
– Efforts should be made to reduce the rate of cesarean sections and provide appropriate care for women with previous cesarean sections.
– Health education programs should be developed to raise awareness about the risks of uterine rupture and the importance of timely and appropriate care during childbirth.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing national policies and guidelines related to maternal health, including uterine rupture prevention and management.
– Healthcare Providers: Obstetricians, midwives, and other healthcare professionals involved in maternal care, responsible for implementing evidence-based practices and providing appropriate care to prevent uterine rupture.
– Community Health Workers: Involved in community education and outreach programs to raise awareness about uterine rupture and promote appropriate care-seeking behavior.
– Non-Governmental Organizations (NGOs): Organizations working in the field of maternal health, providing support, resources, and training to healthcare providers and communities.

Cost Items for Planning Recommendations:

– Training and Capacity Building: Budget for training healthcare providers on evidence-based practices for preventing and managing uterine rupture.
– Equipment and Supplies: Budget for providing necessary equipment and supplies for safe childbirth, including partograph tools, monitoring devices, and emergency obstetric care supplies.
– Health Education and Awareness Campaigns: Budget for developing and implementing health education programs targeting both healthcare providers and the general population.
– Monitoring and Evaluation: Budget for monitoring and evaluating the implementation and impact of intervention programs, including data collection and analysis.
– Infrastructure and Facility Upgrades: Budget for improving healthcare facilities, ensuring they have the necessary infrastructure and resources to provide quality maternal care.
Please note that the cost items provided are general categories and would need to be further detailed and estimated based on the specific context and requirements of the intervention programs.

Força da prova

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is rated 8 because it provides a clear description of the study methodology, including the use of systematic review and meta-analysis. The authors followed the PRISMA guidelines and used a comprehensive search strategy to retrieve relevant studies. The inclusion criteria and data extraction process are also clearly described. The quality assessment of the included studies was conducted using a standardized tool. The prevalence and determinants of uterine rupture in Ethiopia were analyzed using appropriate statistical methods. However, the abstract does not provide information on the sample size of the included studies, which could affect the generalizability of the findings. Additionally, the abstract does not mention any limitations of the study or suggestions for future research. To improve the evidence, the authors could consider including the sample size of the included studies and discussing the limitations and implications of the findings.

Resumo

We conducted this systematic review and meta-analysis of all observational published studies to assess the pooled prevalence and determinants of uterine rupture in Ethiopia. Retrieving of the included studies was done in different databases such as Google scholar, African Journals Online, CINHAL, HINARI, Science Direct, Cochrane Library, EMBASE and PubMed (Medline) without restricting the study period. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline was strictly followed during systematic review and meta-analysis31. A combination of search terms that best describe the study variables were used to retrieve articles. These include risk factors, determinants, predictors, factors, magnitude, prevalence, incidence, uterine rupture, laparotomy, hysterectomy, and Ethiopia. The terms were combined using “OR’ and “AND” Boolean operators. Additionally, reference list of the already identified articles were checked to find additional eligible articles but were missed during the initial searching. Study design All observational studies were included. Study period Studies conducted until August 2018 were included. Participants Women who had given birth at least once before data collection period of the included studies. Language Only articles written in English language were included. Publication status All studies regardless of publication status were considered. Studies which we couldn’t access texts after three emails to the cross ponding authors were excluded. Prevalence uterine rupture was the main outcome of this systematic review and meta-analysis. The pooled prevalence of uterine rupture was determined considering studies in which the status of uterus after delivery was reported. Additionally, determinants of uterine rupture among mothers were the outcome of this study. Data for this study were extracted from the included articles using data extraction checklist. Data extraction was made using Microsoft Excel sheet. Two of the authors (AAA and LBZ) participated in extracting data from the included studies. The data extraction checklist contains variables like author name, publication year, study design, sample size, and exposure characteristics that included the prevalence, partograph utilization, augmentation, residence, obstructed labor, previous Caesarean section (C/S) and antenatal care visit (ANC). An intensive assessment of all articles included in this study was done by the two authors (AAA, MSB, KAG and LBZ). Newcastle–Ottawa assessment checklist32 for observational studies was used to assess the quality of each study included in this research. The tool has three sections. The first section was on methodological assessment and rated out of five stars, and the second section was on comparability evaluation and was rated out of three stars. The third section of the quality assessment tool was on assessing statistical analysis and outcome for each included study. There was a joint discussion between the authors for uncertainty, and the mean quality score was used to decide the quality of the included studies in the meta-analysis. Finally, studies scored ≥ 6 were grouped as having high quality. Important data extracted from each primary (original) study through Microsoft Excel were exported to STATA version 14 software for analysis. Then, standard for each included studies was computed using Binomial distribution formula. To determine the pooled estimate metan STATA command was computed considering random-effect model. Forest plots with 95% confidence interval (CI) were used to present the findings of the study. The weight of each study is described by the size of each box, whereas the crossed line shows the CI at 95%. Publication bias was also assessed using Egger’s and Begg’s tests, and a p-value of less than 0.05 was used to declare its statistical significance33,34. Due to the presence of heterogeneity among33, subgroup analysis was computed considering the geographical region in which the studies were conducted.

Materiais

N/A

Inovações

Based on the information provided, it seems that the focus of the study is on assessing the prevalence and determinants of uterine rupture in Ethiopia. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and retrieved observational published studies from various databases. The study found that the pooled prevalence of uterine rupture in Ethiopia was 3.98%, with the highest prevalence in the Amhara region and the lowest in the Southern Nations, Nationality and Peoples Region (SNNPR). The study also identified several determinants of uterine rupture, including urban residence, primiparity, previous cesarean section, obstructed labor, and partograph utilization.

Based on this information, some potential innovations to improve access to maternal health in Ethiopia could include:

1. Strengthening healthcare infrastructure in rural areas: Since urban residence was identified as a determinant of uterine rupture, improving access to quality maternal healthcare services in rural areas could help reduce the prevalence of uterine rupture.

2. Increasing awareness and education on maternal health: Providing comprehensive education and awareness programs to women and communities about the importance of antenatal care, birth preparedness, and recognizing signs of complications during pregnancy and childbirth can help prevent and manage uterine rupture.

3. Promoting the use of partographs: The study found that partograph utilization was associated with a lower risk of uterine rupture. Implementing training programs for healthcare providers on the proper use of partographs and promoting their use in all healthcare facilities can improve monitoring and early detection of complications during labor.

4. Encouraging access to antenatal care and skilled birth attendants: Primiparity and previous cesarean section were identified as determinants of uterine rupture. Ensuring that all pregnant women have access to antenatal care and skilled birth attendants can help identify and manage risk factors for uterine rupture.

5. Strengthening emergency obstetric care services: Since obstructed labor was found to be a determinant of uterine rupture, improving access to emergency obstetric care services, including timely access to cesarean sections, can help prevent and manage complications that may lead to uterine rupture.

These are just a few potential innovations that could be considered to improve access to maternal health in Ethiopia based on the findings of the study. It is important to note that further research and consultation with healthcare professionals and policymakers would be needed to develop and implement effective interventions.

AI Innovations Description

The recommendation that can be developed into an innovation to improve access to maternal health based on the findings of the systematic review and meta-analysis on uterine rupture in Ethiopia is to implement targeted intervention programs. These programs should focus on addressing the identified determinants of uterine rupture, such as urban residence, primiparity, previous cesarean section, obstructed labor, and partograph utilization.

To improve access to maternal health and reduce the prevalence of uterine rupture, the following innovative strategies can be considered:

1. Strengthening healthcare infrastructure in urban areas: Since urban residence was found to be a determinant of uterine rupture, it is important to improve access to quality maternal healthcare services in urban areas. This can be achieved by increasing the number of healthcare facilities, ensuring availability of skilled healthcare providers, and improving the quality of care provided.

2. Targeted education and awareness campaigns: Primiparity was identified as a determinant of uterine rupture. To address this, targeted education and awareness campaigns can be conducted to provide information and support to first-time mothers. These campaigns can focus on antenatal care, birth preparedness, and the importance of seeking timely medical assistance during labor.

3. Enhancing access to emergency obstetric care: Previous cesarean section and obstructed labor were found to be associated with uterine rupture. To prevent complications and reduce the risk of uterine rupture, it is crucial to ensure timely access to emergency obstetric care, including cesarean section and interventions to manage obstructed labor.

4. Promoting the use of partographs: Partograph utilization was identified as a determinant of uterine rupture. Partographs are graphical records of labor progress that can help healthcare providers identify deviations from normal labor and take appropriate actions. Promoting the use of partographs and providing training to healthcare providers on their proper use can help prevent complications, including uterine rupture.

5. Mobile health (mHealth) interventions: Innovative mHealth solutions, such as mobile applications and text messaging services, can be utilized to improve access to maternal health information and services. These interventions can provide timely reminders for antenatal care visits, educate women about warning signs during pregnancy and labor, and facilitate communication between healthcare providers and pregnant women.

By implementing these innovative strategies, it is possible to improve access to maternal health services, reduce the prevalence of uterine rupture, and ultimately improve maternal and perinatal outcomes in Ethiopia.

AI Innovations Methodology

To improve access to maternal health and address the issue of uterine rupture in Ethiopia, the following innovations and recommendations can be considered:

1. Strengthening healthcare infrastructure: Investing in the development and improvement of healthcare facilities, particularly in rural areas, can help increase access to maternal health services. This includes establishing well-equipped maternity wards, operating theaters, and blood banks to handle emergency cases such as uterine rupture.

2. Training and capacity building: Providing comprehensive training to healthcare providers, including midwives, nurses, and doctors, on the prevention, early detection, and management of uterine rupture can significantly improve maternal health outcomes. This includes training on emergency obstetric care, partograph utilization, and the use of appropriate techniques for managing obstructed labor.

3. Community awareness and education: Conducting community-based awareness campaigns and educational programs can help increase knowledge and awareness about the risks and consequences of uterine rupture. This can empower women and their families to seek timely and appropriate care during pregnancy and childbirth.

4. Mobile health (mHealth) interventions: Utilizing mobile technology to deliver maternal health information, reminders, and alerts can help improve access to healthcare services, especially in remote areas. Mobile applications can provide guidance on pregnancy care, emergency contact information, and reminders for antenatal visits.

To simulate the impact of these recommendations on improving access to maternal health, a methodology can be developed as follows:

1. Define the indicators: Identify key indicators that reflect access to maternal health, such as the number of women receiving antenatal care, the number of deliveries attended by skilled birth attendants, and the number of emergency obstetric interventions performed.

2. Collect baseline data: Gather existing data on the selected indicators to establish a baseline for comparison. This can be obtained from health facilities, surveys, and other relevant sources.

3. Define the intervention scenarios: Develop different scenarios based on the recommended innovations. For example, one scenario could involve the implementation of mHealth interventions, while another scenario could focus on infrastructure development and capacity building.

4. Simulate the impact: Use mathematical modeling or simulation techniques to estimate the potential impact of each scenario on the selected indicators. This can involve projecting the expected changes in the indicators based on the implementation of the innovations.

5. Analyze and compare the results: Evaluate and compare the simulated outcomes of each scenario to determine which interventions are likely to have the greatest impact on improving access to maternal health. Consider factors such as cost-effectiveness, feasibility, and scalability.

6. Refine and implement the chosen interventions: Based on the simulation results, refine the interventions and develop an implementation plan. Monitor and evaluate the progress of the interventions over time to assess their effectiveness and make necessary adjustments.

By following this methodology, policymakers and healthcare stakeholders can make informed decisions on which innovations to prioritize and implement to improve access to maternal health and reduce the prevalence of uterine rupture in Ethiopia.

Autores & Coautores

Statistics:

Citations: 5

Authors: 5

Identifiers:

DOI: 10.1038/s41598-020-74477-z

Research Areas:

Community Interventions, Genetics and Genomics, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cohort Study, Cross Sectional Study, Grounded Theory, randomised-control-trial

Study Approach:

Mixed-methods, Quantitative, Systematic Review

Participants Gender:

Female

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