Incidence of uterine rupture and associated factors in Ethiopia: A systematic review and Meta-analysis

Background: Globally, maternal morbidity and mortality a major public health challenge. Uterine rupture is a life-threatening obstetrical emergency with life-threatening complications for both the mother and her infant. In developing countries, it is the leading cause of maternal and fetal morbidity and mortality. Therefore, this systematic review and meta-analysis aimed to assess the incidence of uterine rupture and its associated factors among mothers managed for obstetric cases in Ethiopia. Method: for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, WHO Afro Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access all the essential articles. This search included all published and unpublished observational studies written only in English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) used for data analysis. Result: A total of 21 studies with 33,303 mothers managed for obstetric cases were included. The pooled incidence of uterine rupture among mothers managed for obstetric cases in Ethiopia was 3.25% (95%CI: 2.6–3.89, I 2 =97.4%, P<0.001). Rural residency (adjusted odds ratio (AOR):5.44; 95% confidence interval (CI): 95%CI: 3.17–9.34, I 2 =59.5%, P=0.03), grand multiparty (AOR = 2.38; 95%CI: 1.32–4.29, I 2 =0.0%, p=0.002), not having antenatal care (AOR =4.05(; 95% CI: 1.90–8.64 I 2 =89.4%, P<0.001), having previous cesarean section scar (AOR =7.10; 95% CI: 5.40–9.34, I 2 =26.3%, P=0.254), having Prolonged labour (AOR=6.71; 95%CI: 4.04–11.15, I 2 =84.6%, P<0.001), having obstructed labour (AOR=7.22; 95%CI: 2.86–18.28, I 2 =97.4%, P<0.001), no partograph utilization for labour monitoring (AOR=3.43; 95%CI: 1.62–7.29, I 2 =66.6%, P=0.05) were the determinant factors for the incidence of uterine rupture in Ethiopia. Conclusion: This systematic review and meta-analysis showed that the incidence of uterine rupture was high in Ethiopia. Being from the rural area, prolonged labour, having cesarean section scar, not using partograph for labour monitoring, not having ante natal care, and obstructed labour increased the risk of uterine rupture.