Author(s)

Fanta Coulibaly¹, Mamadou Keita^2*, Seydou Diallo¹, Dramane Haidara², Alou Samake², Aminata Cisse¹, Saoudatou Tall³, Niagalé Sylla³, Brahima Cisse⁴, Koni Baya², Mamadou Diallo⁵, Moussa Konate⁵, Sidiki Doumbia⁵, Mariam Maiga⁶, Nema Poudiougou⁶, Bocari Sidy Koné⁷, Mahamoud Coulibaly⁸, Mahamadou Keita⁹, Yacouba Sylla⁹, Abdourahmane Dicko¹⁰, Kadidia Ba¹¹, Amadou Boucoum¹²

¹National Office for Reproductive Health, Bamako, Mali.
²Gynaecology and Obstetrics Department of the Reference Health Centre in Commune VI, Bamako, Mali.
³Gynaecology and Obstetrics Department of the Reference Health Centre in Commune V, Bamako, Mali.
⁴National Centre for University Works of Kabala, Kabala, Mali.
⁵Department of General Surgery of the Reference Health Centre in Commune VI, Bamako, Mali.
⁶Department of Pediatrics of the Reference Health Centre in Commune VI, Bamako, Mali.
⁷Perinatal Clinic of Mohamed 6, Bamako, Mali.
⁸Gynaecology and Obstetrics Department of the Reference Health Centre in Kalanban Koro, Koulikoro, Mali.
⁹Gynaecology and Obstetrics Department of the Reference Health Centre in Commune I, Bamako, Mali.
¹⁰Gynaecology and Obstetrics Department of the Reference Health Centre in Ouelessebougou, Koulikoro, Mali.
¹¹Bamako District Health Department, Bamako, Mali.
¹²Faculty of Medicine, University of Science and Technology of Bamako, Bamako, Mali.

Introduction: The last two decades have coincided with a rapid increase in the caesarean rate in most countries, including developing countries. A previous caesarean section constitutes an obstetric morbidity in late pregnancy. The objective of our work was to study childbirth in women with uterine scars at the Health Centre of Reference in Commune VI (CSRéf-CVI) of the district of Bamako. Materials and Methods: It was a transversal and analytic study with the collection of prospective data, which took place over a period of six months from January 1 to June 30, 2022. It was carried out in the gynecological-obstetric section of the Reference Health Center of Commune VI (CSRéf-Cvi), Bamako. Results: Our study recorded 710 deliveries on scarred uterus out of 6347 deliveries at the maternity of Csréf, Commune VI, District of Bamako, representing a prevalence of 11.2%. The number of uterine scars varied between one and four. Caesarean section was the major cause of uterine scar (97%). Women who had four (4) or more prenatal consultations accounted for 56% of cases, whereas those who had fewer than four (4) prenatal consultations accounted for 42%. Delivery was by iterative caesarean section in 82.7% of cases and by natural birth in 17.3% of cases. The most frequent indication for iterative caesarean section was scarred uterus on limited pelvis (16.1%), followed by bi-scarred uterus (13.3%) and failure of work test (13.1%). The uterine test was performed in 28.5% of cases (200/710), with a success rate of 61.5% (123/200). The maternal prognosis was marked by simple sequelae in 80.6% of cases and complicated sequelae in 19.4%, including surgical area infection (7.8%), postpartum haemorrhage (3.2%), endometritis (0.7%) and evisceration (0.2%). Laparotomy revealed an intact uterus in 97.8% of cases, dehiscence of the uterine scar in 1.7% and uterine rupture in 0.5%. No maternal deaths were recorded. The fetal prognosis was marked by live newborns in 98.5% of cases; 15 newborns were breastfed and resuscitated, three (3) without success. Overall, 92.2% of newborns weighed between 2500 and 3999 g and 2.3% weighed ≥ 4000 g. Conclusion: Delivery on a scarred uterus is frequent; the existence of a uterine scar influences the decision on iterative caesarean. Uterine breaking is a major complication that can jeopardize the obstetrical prognosis of women as well as the vital prognosis of the mother-child couple. Prenatal consultation is essential in cases of pregnancy on a scarred uterus. It allows early screening for and healing of the maternal-fetal morbidity linked to a scarred uterus.

Delivery, Scarred Uterus, Uterine Test, Maternal, Fetal Caesarean Prognosis

Coulibaly, F. , Keita, M. , Diallo, S. , Haidara, D. , Samake, A. , Cisse, A. , Tall, S. , Sylla, N. , Cisse, B. , Baya, K. , Diallo, M. , Konate, M. , Doumbia, S. , Maiga, M. , Poudiougou, N. , Koné, B. , Coulibaly, M. , Keita, M. , Sylla, Y. , Dicko, A. , Ba, K. and Boucoum, A. (2025) Delivery on Scarred Uterus at the Reference Health Centre of Commune VI, Bamako, Mali. Open Journal of Obstetrics and Gynecology, 15, 1341-1353. doi: 10.4236/ojog.2025.158111.