Table Of Contents
Uterine rupture
Uterine rupture is complete separation of the wall of the uterus i.e separation of the myometrium and perimetrium. When the perimetrium remains intact, it is called uterine dehiscence or incomplete rupture. Uterine rupture is more commonly associated with uterine scarring from a classical caesarean incision. It leads to significant bleeding and the contents of the uterus may be released into teh peritoneal cavity. It carries a high morbidity and mortality for the mother and fetus.
- Risk factors
- Uterine scarring
- Caesarean incision (usually classic)
- Myomectomy (especially one which breaches the endometrium)
- Trauma
- Instrumentation
- Elective abortion
- Excessive uterine stimulation e.g. induction of labour using misoprostol, oxytocin for augmentation
- Short intrapregnancy interval < 12 months
- Uterine anomalies
- History of invasive molar pregnancy
- History placenta percreta/increta
- Malpresentation
- Fetal anomaly
- Cocaine abuse
- Uterine scarring
- Signs and symptoms of impending rupture
- Maternal tachycardia (> 100 bpm)
- Localized abdominal pain
- Per vaginal bleeding
- Foetal distress (irregular heart rate or meconium stained liquour)
- Signs and symptoms of uterine rupture
- Tearing uterine (abdominal) pain
- “Popping sensation” (relieving pressure within the uterus)
- Painful late pregnancy bleeding
- Cessation or abnormalities of contractions
- Loss of fetal station
- Fetal distress (late deceleration – most reliable sign)
- Treatment
- Resuscitation (ABCs, including blood transfusion)
- Emergency caesarean delivery
- Uterine repair or hysterectomy
