TITLE:
Delivery on Scarred Uterus at the Reference Health Centre of Commune VI, Bamako, Mali
AUTHORS:
Fanta Coulibaly, Mamadou Keita, Seydou Diallo, Dramane Haidara, Alou Samake, Aminata Cisse, Saoudatou Tall, Niagalé Sylla, Brahima Cisse, Koni Baya, Mamadou Diallo, Moussa Konate, Sidiki Doumbia, Mariam Maiga, Nema Poudiougou, Bocari Sidy Koné, Mahamoud Coulibaly, Mahamadou Keita, Yacouba Sylla, Abdourahmane Dicko, Kadidia Ba, Amadou Boucoum
KEYWORDS:
Delivery, Scarred Uterus, Uterine Test, Maternal, Fetal Caesarean Prognosis
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.15 No.8,
August
29,
2025
ABSTRACT: 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.