Incidence, determinants and outcomes of uterine rupture among women at a referral hospital in Taiz City, Yemen: a retrospective analysis from a conflict-affected setting

Background: Uterine rupture is An uncommon but serious obstetric emergency, particularly in low-resource and conflict-affected settings. However, data on its burden in Yemen is limited. Therefore, this study assessed the incidence, determinants and outcomes of uterine rupture among women admitted to a tertiary care hospital in Taiz City, southwest of the country. Methods: A retrospective surveillance study with an integrated case-control analysis was conducted at the Republican General Teaching Hospital in Taiz during 2023. All women with uterine rupture during the study period were included as cases, while controls were randomly selected from those delivered without uterine rupture. Demographic, obstetric, intrapartum and outcome data were extracted from medical records. Associations between uterine rupture and its determinants were assessed at a significance level of <0.05. Results: Out of 8,550 deliveries, 23 cases of uterine rupture were identified, resulting in an incidence of 2.7 per 1,000 deliveries. Most ruptures were complete (82.6%). Rural residence (OR = 4; 95% CI: 1.39–11.49; P = 0.008), interpregnancy interval (IPI) <24 months (OR = 5.2; 95% CI: 1.16–23.08; P = 0.030), and breech fetal malpresentation (OR = 21.9; 95% CI: 1.13–426.9; P = 0.008) were significantly associated with uterine rupture. Substantial maternal morbidity was observed, including bladder rupture (21.7%), severe blood loss (26.1%), and need for transfusion (43.5%). Hysterectomy was performed in 13% of cases. One woman died, whereas stillbirths occurred in 27.3% of cases. Conclusion: The incidence of uterine rupture in Taiz City exceeds regional and global estimates and is associated with substantial maternal and perinatal morbidity, including bladder rupture, severe blood loss, need for blood transfusion, hysterectomy, and stillbirth. Rural residence, short IPIs, and breech presentation are key determinants, showing inequities in maternal care and the need to strengthen antenatal services, referral systems, and antenatal care services.