Pregnancy and childbirth complications claim the lives of many women of childbearing age in developing countries, sending them to early graves. The World Bank reports that over 99 percent of recorded maternal deaths occur in these regions. Maternal mortality, defined as the death of a woman during pregnancy, childbirth, or within a year after the end of a pregnancy, affected approximately 287 000 women worldwide in 2020, according to the World Health Organization. Sub‑Saharan Africa alone accounted for about 70 percent of those deaths. The primary causes are severe bleeding (postpartum haemorrhage), infections, high blood pressure during pregnancy, delivery complications, and unsafe abortion. These direct causes are linked to broader factors such as unskilled birth attendants, poor referral systems, inadequately equipped hospitals, poverty, and lack of education.
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, responsible for roughly 140 000 deaths each year—one woman dies every four minutes. According to the Mayo Clinic, bleeding during pregnancy can result from an incompetent cervix, miscarriage, placental abruption, preterm labour, or uterine rupture. Uterine rupture, a tear of the uterine wall during pregnancy or delivery, is associated with fetal distress, massive maternal haemorrhage, and often necessitates a caesarean section. Complications include neonatal death, hysterectomy, infertility, and increased risk of maternal mortality. While earlier studies suggested uterine rupture contributed little to maternal deaths, recent observations by obstetricians and gynaecologists indicate a rising trend.
A 2019 secondary analysis of the Nigeria Near‑miss and Maternal Death Survey by S. J. Etuk et al. examined 91 724 live births, identifying 3 285 severe maternal outcomes and 392 uterine ruptures. Uterine rupture accounted for 11.9 percent of severe maternal outcomes, 13.3 percent of maternal near‑miss cases, and 8.7 percent of maternal deaths. Contributing, avoidable factors included delayed hospital presentation, lack of insurance for life‑saving interventions, and personnel shortages. The study concluded that uterine rupture significantly impacts maternal mortality in Nigeria.
Earlier research supports this upward trend. G. O. Akaba et al. (2013) reported 82 uterine ruptures among 9 604 deliveries (2006‑2010), attributing them to injudicious oxytocin use (38.7 percent), previous caesarean scars (28.0 percent), and prolonged obstructed labour (18.7 percent). T. Ogunowo et al. (2003) documented 35 ruptures out of 4 531 live births (1996‑2000), noting an increase compared with a decade earlier. Percentages rose from 0.72 percent (1996‑2000) to 0.85 percent (2006‑2010) and 11.9 percent (2019).
Dr Chris Aimakhu, Secretary of the Society of Gynaecology and Obstetrics, identified risk factors for uterine rupture: prior surgery (caesarean section, myomectomy, abortion), high parity, induced labour with oxytocin, twin pregnancies, and assisted deliveries. He explained that these conditions weaken the uterine wall, making it vulnerable to tearing during unsupervised labour. “We are observing more cases now than a year or two ago,” Aimakhu noted, citing five to six recent ruptures at University College Hospital, Ibadan.
Dr Babatunde Adewunmi, a public‑health physician and founder of Quinta Health, reported four uterine ruptures at Federal Medical Centre, Abeokuta, and highlighted contributing factors such as women attempting vaginal birth after caesarean, illiteracy, and inadequate health education for unskilled attendants. Dr Ebiye Tekenah, Consultant Obstetrician/Gynaecologist at Federal Medical Centre, Yenagoa, emphasized that women with previous caesarean scars are especially at risk when they attempt vaginal delivery, and that unskilled birth attendants and misuse of uterotonic drugs further increase the danger. He warned that abdominal massage to “turn the baby” can triple the risk of rupture in scarred uteri, leading to maternal haemorrhage and mortality rates of 30‑40 percent when care is delayed.
The clinicians collectively urged women with prior caesarean sections to register subsequent pregnancies at secondary or tertiary facilities, avoid abdominal massage, and attend regular antenatal clinics. They called for improved family‑planning services, reliable referral systems, and transportation, particularly in rural areas lacking equipped hospitals, to reduce prenatal and maternal mortality.
Regarding clinical presentation, Aimakhu described complete uterine rupture as a situation where the fetus emerges through the tear into the abdominal cavity, accompanied by vaginal or internal bleeding, hypotension, rapid pulse, and fainting. He also warned against unsupervised oxytocin use and over‑the‑counter misoprostol for labour induction, especially in women with previous scars.
Adewunmi added that vaginal birth after caesarean is possible only in facilities capable of performing emergency caesarean sections. He noted that traditional birth attendants may administer uterine‑contracting medications, increasing rupture risk. Additional risk factors include abdominal trauma, congenital uterine anomalies, and polyhydramnios (excess amniotic fluid), which can over‑distend the uterus.
Both experts concluded that “safe motherhood” requires clean, skilled deliveries, education on the importance of registered and equipped health facilities, and government investment in trained staff and infrastructure to ensure safe antenatal care and childbirth.
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