Determinants of hysterectomy, maternal mortality and perinatal mortality among uterine rupture cases: an eight-year retrospective study in Niger

Background Uterine rupture remains a major obstetric emergency in low-resource settings, and is associated with severe maternal and perinatal morbidity and mortality. Evidence from Sahelian countries remains limited. This study aimed to determine the incidence, determinants, and outcomes of uterine rupture in a tertiary referral hospital in Niger. Methods We conducted a retrospective study of all cases of uterine rupture managed between January 1, 2015, and December 31, 2022, in the obstetrics department of a tertiary referral hospital. Sociodemographic characteristics, obstetric factors, clinical management, and maternal and perinatal outcomes were analyzed. Temporal trends were assessed using the Chi-Square test for trend, and multivariable logistic regression was performed to identify independent factors associated with maternal mortality, perinatal mortality, and hysterectomy. Results During the study period, 26,971 deliveries were recorded, including 408 cases of uterine rupture, yielding an incidence of 1.51% (15.1 per 1,000 deliveries). Most women were from rural areas (66.9%) and had no formal education (92.6%). The majority of patients were referred from peripheral health facilities (91%), and more than half experienced a referral delay exceeding 12 hours (54.2%). Uterine repair was performed in 65% of cases, while 35% required hysterectomy. Maternal mortality was 3.4% (14 deaths/408), and perinatal mortality was 76.7% (313/408). Rural origin (aOR 6.04; 95% CI 1.1–7.2; P = 0.03), blood transfusion (aOR 3.91; 95% CI 1.5–10.1; P = 0.004), and hypovolemic shock (aOR 50; 95% CI 31.21–69.98; P = 0.002) were independently associated with maternal death. Perinatal mortality was significantly associated with rural residence (aOR 1.2; 95% CI 1.5–4.4; P < 0.001), grand multiparity (aOR 1.83; 95% CI 1.1–3.0; P = 0.003), non-scarred uterus (aOR 1.78; 95% CI 1.1–2.8; P = 0.002), and blood transfusion (aOR 2.37; 95% CI 1.3–4.1; P = 0.003). Temporal analysis showed significant variation in incidence over time (χ² trend = 22.55; P = 0.002) and a marked decline in maternal mortality after 2016. Conclusion Uterine rupture remains associated with extremely high maternal and perinatal mortality in low-resource settings. Strengthening referral systems, improving intrapartum monitoring, and ensuring timely surgical intervention are essential to reduce adverse outcomes.