Uterine Rupture

General

• Most common in patients with previous cesarean delivery scars
• Rupture in the absence of a previous scar is uncommon
• 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
• Trauma may result secondary to attempts to remove a retained placenta manually or with instrumentation
• Location
• Corpus with rupture before onset of labor
• Lower uterine segment during labor

Risk factors

• Patients with prior classic hysterotomy have higher rate of uterine rupture in subsequent pregnancies
• Those who have had 2 or more hysterotomies
• Those who are treated with prostaglandin agents and have undergone a previous caesarian have highest risk
• Those who undergo induction of labor have small increased risk

Clinical findings

• Acute abdominal pain
• “Popping” sensation
• Palpation of fetal parts outside of the confines of the uterus
• Repetitive or prolonged fetal heart rate deceleration
• Vaginal bleeding ─ early post-partum hemorrhage

Diagnosis is clinical

• Ultrasound may be useful if immediately available

Treatment

• Presence of uterine rupture dictates laparotomy be performed
• Treatment consists of immediate cesarean delivery with probable hysterectomy.
• Repair of uterus may be possible in some cases

Prognosis

• 2-20% maternal mortality
• 10-25% fetal mortality

 
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.