·
General
o
Most
common
in
patients
with
previous
cesarean
delivery
scars
§
Rupture
in the
absence
of a
previous
scar
is
uncommon
o
Uterine
trauma
may
occur
following
very
prolonged
or
vigorous
labor
§
Especially
if
patient
has
relative
or
absolute
cephalopelvic
disproportion,
and
Uterus
has
been
stimulated
with
oxytocin
or
prostaglandins
o
Trauma
may
result
secondary
to
attempts
to
remove
a
retained
placenta
manually
or
with
instrumentation
o
Location
§
Corpus
with
rupture
before
onset
of
labor
§
Lower
uterine
segment
during
labor
·
Risk
factors
o
Patients
with
prior
classic
hysterotomy
have
higher
rate
of
uterine
rupture
in
subsequent
pregnancies
§
Those
who
have
had 2
or
more
hysterotomies
o
Those
who
are
treated
with
prostaglandin
agents
and
have
undergone
a
previous
caesarian
have
highest
risk
o
Those
who
undergo
induction
of
labor
have
small
increased
risk
·
Clinical
findings
o
Acute
abdominal
pain
o
“Popping”
sensation
o
Palpation
of
fetal
parts
outside
of the
confines
of the
uterus
o
Repetitive
or
prolonged
fetal
heart
rate
deceleration
o
Vaginal
bleeding
─
early
post-partum
hemorrhage
·
Diagnosis
is
clinical
o
Ultrasound
may be
useful
if
immediately
available
Uterine
rupture.
Contrast-enhanced
CT
scan
through
the
pelvis
demonstrates
the
non-involuted
uterus
with a
large
discontinuity
representing
the
rupture
in the
right
posterolateral
wall
(blue
arrow).
There
is a
considerable
amount
of
blood
(red
arrow)
in the
pelvis.
The
pelvic
veins
are
dilated
from
the
recent
pregnancy.
Click here for
this photo
without
the
arrows
·
Treatment
o
Presence
of
uterine
rupture
dictates
laparotomy
be
performed
o
Treatment
consists
of
immediate
cesarean
delivery
with
probable
hysterectomy.
o
Repair
of
uterus
may be
possible
in
some
cases
·
Prognosis
o
2-20%
maternal
mortality
o
10-25%
fetal
mortality
