- Scarred Uterus Rupture: Previous caesarean scar or myomectomy
- Unscarred Uterus Rupture: Obstructed labour, Trauma, Grand-multiparty, Uterine anomaly or injudicious use of oxytocin or prostaglandins
- Severe haemorrhage, Tachycardia, Hypotension (Shock)
- Palpable fetal parts with loss of fetal station
- Recession of presenting fetal parts
- Prolonged, Persistent, Profound fetal bradycardia
- Loss of uterine contractility
- Appearance of placenta at vulva
- Prolapsed loops of gut into vagina
USG: Fetus in peritoneal cavity, Free fluid seen
- Abruptio Placentae (Similar presentation)
- Hepatic Rupture in severe pre eclampsia (Look for other signs of pre-eclampsia)
- Chorioamnionitis (Look for fever, PROM, Tender uterus)
ABC (Wide bore cannulas, fluids, O2, Blood Products)
Stop oxytocin if in progress
Type and Cross Match
Mobilising resources quickly is the key (OBGYN, Anaesthesia, Neonatology)
Immediate laparotomy is indicated
- Vertical incision gives better access
- Fetus lies partially or completely in the abdominal cavity
- Rent repair or hysterectomy are the surgical options depending on the degree of rupture and damage
- When dealing with trauma in pregnancy, think Placental Abruption and Uterine Rupture (Both can co-exist)
- Establishing diagnosis early and mobilising the resources quickly and effectively results in favourable outcomes for the mother and fetus
For further reading:
- Qudsia, Q. A. Z. I., et al. "Woman health; uterus rupture, its complications and management in teaching hospital bannu, pakistan." Maedica 7.1 (2012): 49.
- Blanchette H, Blanchette M, McCabe J, Vincent S. Is vaginal birth after cesarean safe? Experience at a community hospital. Am J Obstet Gynecol. 2001 Jun. 184(7):1478-84; discussion 1484-7.
- Leung AS, Leung EK, Paul RH. Uterine rupture after previous cesarean delivery: maternal and fetal consequences. Am J Obstet Gynecol. 1993 Oct. 169(4):945-50.
- Yap OW, Kim ES, Laros RK Jr. Maternal and neonatal outcomes after uterine rupture in labor. Am J Obstet Gynecol. 2001 Jun. 184(7):1576-81
- Essentials of Obstetrics - Lakshmi Seshadri and Gita Arjun
- Batra, Kanika, et al. "Determinants of rupture of the unscarred uterus and the related feto-maternal outcome: current scenario in a low-income country." Tropical doctor (2015): 0049475515598464.
- A Massinde, E Ndaboine, A Kihunrwa. An unusual case of placenta abruption complicated with ruptured uterus: case report. The Internet Journal of Gynecology and Obstetrics. 2009 Volume 13 Number 1.
Aarupadai Veedu Medical College
Edited by Lakshay Chanana @EMDidactic