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A - MSRA Obstetrics [16] > [42] Uterine Rupture > Flashcards

[42] Uterine Rupture Flashcards

1
Q

What is a uterine rupture?

A

A full thickness disruption of the uterine muscle and overlying serosa

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2
Q

When does uterine rupture occur?

A

Typically during labour

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3
Q

What can uterine rupture extend to affect?

A

Bladder or broad ligament

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4
Q

What are the main types of uterine rupture?

A
  • Incomplete

- Complete

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5
Q

What is an incomplete uterine rupture?

A

When the peritoneum overlying the uterus is in tact, and so the uterine contents remain with the uterus

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6
Q

How does an incomplete uterine rupture present?

A

Usually asymptomatic

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7
Q

Does an incomplete uterine rupture require emergency surgery?

A

No

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8
Q

What is a complete uterine rupture?

A

Peritoneum is also torn, and uterine contents can escape into the peritoneal cavity

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9
Q

What are the types of complete uterine rupture?

A
  • Traumatic

- Spontaneous

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10
Q

What can cause a traumatic uterine rupture?

A
  • Motor vehicle accident
  • Incorrect use of oxytocin agent
  • Poorly conducted attempt at operative vaginal delivery
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11
Q

In whom can spontaneous uterine rupture occur in?

A

Patients with a history of C-section or trauma that could have caused permanent damage

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12
Q

What is the incidence of uterine rupture in an unscarred uterus?

A

Extremely rare - 6 in 10,000 deliveries

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13
Q

What is the incidence of uterine rupture following C-section when VBAC is attempted?

A

22-74/10,000

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14
Q

In general, what are the risk factors for uterine rupture?

A

Those that make the uterus inherently weaker

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15
Q

What are the risk factors for uterine rupture?

A
  • Previous C-section
  • Previous uterine surgery
  • Induction or augmentation of labour
  • Obstruction of labour
  • Multiple pregnancy
  • Multiparity
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16
Q

What is the biggest risk factor for uterine rupture?

A

Previous C-section

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17
Q

What % of cases of uterine rupture occur when there has been a previous C-section?

A

87%

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18
Q

What type of C-section carries the greater risk of uterine rupture?

A

Classical (vertical) incisions

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19
Q

Give an example of. uterine surgery that increases the risk of uterine rupture?

A

Myomectomy

20
Q

What kind of induction in particular increases the risk of uterine rupture?

A

Prostaglandins

21
Q

When is obstruction of labour an important risk factor to consider for uterine rupture?

A

In developing countries

22
Q

Why can the diagnosis and prompt management of uterine rupture be difficult?

A

Because the initial clinical features of uterine rupture are non-specific

23
Q

What is the most common presenting symptom of uterine rupture?

A

Sudden, severe abdominal pain, which persists between contractions

24
Q

What other presenting symptoms might a patient with uterine rupture experience?

A
  • Shoulder-tip pain

- Vaginal bleeding

25
Q

What causes shoulder tip pain in uterine rupture?

A

Diaphragmatic irritation

26
Q

What may be found on examination in uterine rupture?

A
  • Regression of presenting part
  • Abdominal palpation revealing scar tenderness and palpable fetal parts
  • Features of hypovolaemic shock
27
Q

When might there be features of hypovolaemic shock in uterine rupture?

A

If significant haemorrhage

28
Q

What might fetal monitoring reveal in uterine rupture?

A

Distress or absent heart sounds

29
Q

What are the differentials for uterine rupture?

A
  • Placental abruption
  • Placenta praevia
  • Vasa praevia
30
Q

What is vital monitoring in women at risk of uterine rupture?

A

Intrapartum monitoring with CTG

31
Q

What are early indicators of uterine rupture on CTG?

A
  • Recurrent or late decelerations

- Prolonged fetal bradycardia

32
Q

What often happens when there is a pathological CTG with uterine rupture?

A

The pathological CTG prompts the emergency C-section, and uterine rupture is noted intra-operatively

33
Q

What can be used for diagnosis if there is a suspicion of uterine rupture in the pre-labour setting?

A

Ultrasound

34
Q

What features may be present on ultrasound in uterine rupture?

A
  • Abnormal fetal lie or position
  • Haemoperitoneum
  • Absent uterine wall
35
Q

What initial management is required as a result of uterine rupture being an obstetric emergency?

A
  • A-E approach
  • Call appropriate staff
  • Where appropriate, invoke massive obstetric haemorrhage protocol
36
Q

What is involved in resuscitation in uterine rupture?

A
  • Protect airway
  • 15L of 100% oxygen through non-rebreathe mask
  • Assess circulatory compromise
  • Monitor patients GCS
  • Expose patient to identify any other bleeding sources
37
Q

When might the airway be lost in uterine rupture?

A

With reduced levels of consciousness

38
Q

How can circulatory compromise be assessed?

A
  • Cap refill
  • BP
  • ECG
39
Q

What should be inserted during resuscitation for uterine rupture?

A

2 large bore (14G) cannulas

40
Q

What should be done with the cannulas inserted in uterine rupture?

lol what a bad question

A
  • Take blood samples

- Start circulatory resuscitation

41
Q

What is given in circulatory resuscitation in uterine rupture?

A

Give cross-matched blood as soon as available, but until then give up to 2L of warmed crystalloid and 1-2L of warmed colloids, then transfuse O negative or uncrossmatched group specific blood

42
Q

What additional blood products may be required in uterine rupture?

A
  • Fresh frozen plasma
  • Platelets
  • Fibrinogen
43
Q

What is the definitive management for uterine rupture?

A

The fetus is delivered by C-section, and the uterus is either repair or removed

44
Q

What are the UK guidelines for the decision-incision interval in uterine rupture?

A

Should be less than 10 minutes

45
Q

What are the complications of uterine rupture?

A
  • Post-op infection
  • Damage to ureter
  • Amniotic fluid embolus
  • Massive maternal haemorrhage and DIC
  • Pituitary failure
46
Q

What % of uterine ruptures are associated with perinatal death?

A

6.2%

47
Q

What % of women with uterine rupture require an emergency hysterectomy?

A

14-33%

A - MSRA Obstetrics [16] (61 decks)

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