Uterine rupture

Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
 In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part

Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta

Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture

1. Uterine Rupture Deepa Mishra Assistant Professor (OBG)

2. Introduction Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present . Disability or death of the mother or baby may result.

3. Definition Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus .

4. Incidence Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9 % Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section .  In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000 Risk of death of the baby is about 6%

5. Etiology

6. Risk Factors Previous cesarean section Myomectomy Dysfunctional labor Labor augmentation by oxytocin or prostaglandins High parity First pregnancy- very rare

7. Types of uterine rupture Complete Rupture All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity. Usually results in death Incomplete Rupture Visceral peritoneum is intact and usually the fetus remains in the uterine cavity

8. Sign & Symptoms Uterine dehiscence and abdominal pain and vaginal bleeding Deterioration of fetal heart rate Loss of fetal station on manual vaginal exam Hypovolemic shock due to intrabdominal bleeding Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum Cessation of uterine contractions Palpation of fetus outside the uterus Signs of abdominal pregnancy Post term pregnancy

9. Diagnosis Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring Absent fetal heart sound On PV hot, dry vagina with a large caput over the presenting part

10. Prevention Early diagnosis and management of CPD mal presentation and obstructed labor Proper selection of cases for vaginal delivery Carefull monitoring of oxytocin infusion specially in multipara Avoid intra uterine manipulation no version in single fetus Instrumental delivery after cervical dilatation Immediate CS in obstructed labor Hospital delivery for high risk cases ECV should be avoided during general anaesthesia Careful manual removal of placenta

11. Treatment Resuscitation with adequate hydration and blood transfusion Laprotomy Hysterectomy Repair

12. Complication Rupture uterus with haemorrhage, shock and sepsis Fetal loss is high in spontaneous and traumatic rupture Mortality is low in LSCS scar rupture