Study of Childbirth with A Single Scar Uterus at the "Major Moussa Diakite" Reference Health Center in Kati, Mali

Abstract

The management of childbirth in a scarred uterus is one of the most debated subjects in modern obstetrics, due to the considerable increase in caesarean section rates and many other risks of complication such as disunion of the old scar. Objective: To study childbirth with a single scar uterus at the Kati Reference Health Center. Method: This was a prospective cross-sectional study, which ran from 1 January to 31 December 2021. It focused on parturients with a single myometrial scar, a vertex presentation of the foetus, a clinically normal pelvis, a uterine height of less than 36 centimeters, a single foetal pregnancy and an intergenesic interval of more than one year. Results: Out of a total of 2521 deliveries, seventy (70) women met the criteria of our study, or a frequency of 28%. The average age of parturients was 30, with extremes ranging from 18 to 42. Only 20% of our parturients had completed four antenatal consultations. They were carried out in 78.5% of cases by qualified staff. Eight out of ten of our parturients (81.4%) came on their own, and in seven out of ten cases (70.0%) in the active phase of childbirth. Delivery was by natural route in almost seven out of ten cases (65.7%), compared with caesarean section in 34.3% of cases. The indications for caesarean section were dominated by dynamic dystocia (66.7%), followed by failure to engage (12.5%), acute foetal distress (12.5%) and umbilical cord prolapse (8.3%). Previous vaginal delivery prior to caesarean section was associated with a successful uterine test (P=0.019). Maternal complications were haemorrhage due to uterine atony (1 case) and disunion of the old caesarean scar (1 case). We recorded two macerated stillbirths and one case of early neonatal death linked to extreme prematurity, and six cases of neonatal suffering. Conclusion: Childbirth in a scar uterus is a high-risk delivery, and strict adherence to the conditions under which it is carried out is essential to improve the maternal and ....