@article{fdi:010074363,
  title = {{P}redictors of uterine rupture in a large sample of women in {S}enegal and {M}ali : cross-sectional analysis of {QUARITE} trial data},
  author = {{D}elafield, {R}. and {P}irkle, {C}. {M}. and {D}umont, {A}lexandre},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground{T}he purpose of this study was to investigate predictors of uterine rupture in a large sample of sub-{S}aharan {A}frican women. {U}terine rupture is rare in high-income countries, but it is more common in low-income settings where health systems are often under-resourced. {H}owever, understanding of risk factors contributing to uterine rupture in such settings is limited due to small sample sizes and research rarely considers system and individual-level factors concomitantly.{M}ethods{C}ross-sectional data analysis from the pre-intervention period ({O}ct. 1, 2007- {O}ct. 1, 2008) of the {QUARITE} trial, a large-scale maternal mortality study. {T}his research examines uterine rupture among 84,924 women who delivered in one of 46 referral hospitals in {M}ali and {S}enegal. {A} mixed-effects logistic regression model identified individual and geographical risk factors associated with uterine rupture, accounting for clustering by hospital.{R}esults{F}ive hundred sixty-nine incidences of uterine rupture (0.67% of sample) were recorded. {P}redictors of uterine rupture: grand multiparity defined as >5 live births (a{OR}=7.57, 95%{CI}; 5.19-11.03), prior cesarean (a{OR}=2.02, 95%{CI}; 1.61-2.54), resides outside hospital region (a{OR}=1.90, 95%{CI}: 1.28-2.81), no prenatal care visits (a{OR}=1.80, 95%{CI}; 1.44-2.25), and birth weight of >3600g (a{OR}=1.61, 95%{CI}; 1.30-1.98). {W}omen who were referred and who had an obstructed labor had much higher odds of uterine rupture compared to those who experienced neither (a{OR}: 46.25, 95%{CI}; 32.90-65.02).{C}onclusions{T}he results of this large study confirm that the referral system, particularly for women with obstructed labor and increasing parity, is a main determinant of uterine rupture in this context. {I}mproving labor and delivery management at each level of the health system and communication between health care facilities should be a priority to reduce uterine rupture.},
  keywords = {{U}terine rupture ; {S}ub-{S}aharan {A}frica ; {D}elivery of health care ; {D}ystocia ; {R}eferral and consultation ; {SENEGAL} ; {MALI} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{BMC} {P}regnancy and {C}hildbirth},
  volume = {18},
  numero = {},
  pages = {art. 432 [8 ]},
  ISSN = {1471-2393},
  year = {2018},
  DOI = {10.1186/s12884-018-2064-y},
  URL = {https://www.documentation.ird.fr/hor/fdi:010074363},
}