Uterine rupture and associated factors among pregnant women at Hoima Regional Referral Hospital in Uganda: A case-control study

Background Uterine rupture remains a severe obstetric emergency and is a major contributor to maternal and neonatal morbidity and mortality, particularly in low-resource settings. The condition results from disruption of the uterine wall during pregnancy or labour and requires urgent surgical management. Understanding the factors associated with uterine rupture is essential for improving early identification, prevention, and maternal health outcomes, especially in referral hospitals serving large rural populations. Methods A hospital-based case-control study was conducted using retrospective medical records at Hoima Regional Referral Hospital. Cases were women who experienced uterine rupture and underwent laparotomy, while controls were women who delivered without uterine rupture. Data were extracted using a standardized checklist. Descriptive statistics were generated, and both bivariate and multivariable logistic regression analyses were performed to identify factors independently associated with uterine rupture. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to estimate the strength of associations. Results Women with a previous uterine scar had significantly increased odds of uterine rupture (AOR = 5.6; 95% CI: 2.8–11.1). Educational attainment showed a protective effect, with lower odds of uterine rupture among women with primary education (AOR = 0.29; 95% CI: 0.086–0.977) and secondary education (AOR = 0.16; 95% CI: 0.047–0.527) compared to women with no formal education. Distance to healthcare facilities was also a key determinant; women residing more than five kilometers from a health facility had markedly higher odds of uterine rupture (AOR = 12.75; 95% CI: 1.477–110.108). Conclusion Both socio-demographic and clinical factors contribute significantly to the occurrence of uterine rupture. Previous caesarean delivery, low educational attainment, and delayed access to obstetric care were major risk factors. Strengthening antenatal education, improving referral and emergency obstetric services, and enhancing access to healthcare for women in remote communities are critical for reducing the burden of uterine rupture. Establishing maternal waiting homes may further reduce delays in accessing timely care and improve maternal and neonatal outcomes.