(423) A case-control study of uterine rupture in Caluquembe, Angola, 2019–2025: Adverse obstetric and perinatal outcomes

Our rural district hospital serves remote and sometimes inaccessible regions of Huila province, Angola, where two physicians and two technicians provide surgical care for a catchment area of more than half a million people. Although many cases are preventable, uterine rupture remains a leading cause of maternal mortality in Angola. We sought to identify risk factors for poor maternal and fetal outcomes related to uterine rupture.

Study Design:
We conducted a date-of-delivery-matched case-control study of 187 uterine ruptures and 187 controls in Hospital Evangélico de Caluquembe in Huila province, Angola in 2019–2025.  Odds ratios and logistic regression were used to compare the two populations.

Results:
Thirteen uterine rupture cases resulted in maternal mortality, and a live birth was documented in only 22 cases. Cases had greater odds of maternal death (OR=7.8 (2.0, 52.0)) and stillbirth (OR=89.9 (44.1, 195.1)). Increased time from home to the hospital in hours (OR=1.2 (1.1, 1,4)) and multiparity (OR=1.3 (1.1, 1.6)) were both associated with stillbirths. Five surviving uterine ruptures received hysterectomy rather than uterine repair. Additionally, bladder rupture was documented in five cases.

Conclusion:
Building capacity for surgical delivery at critical access hospitals, strengthening referral networks for women in labor in rural areas, and increasing access to modern contraception among women with higher parity are necessary for reducing burden from uterine rupture.