Ruptured Uterus

Question 1

When does a ruptured uterus occur?

Answer 1

Late pregnancy or during labour

Question 2

What are the 2 types of ruptured uterus?

Answer 2

Complete and incomplete

Question 3

What happens when a complete rupture occurs?

Answer 3

Full thickness of the uterus wall and pelvic peritoneum ruptures

Question 4

What happens when an incomplete rupture occurs?

Answer 4

Involves tearing of the uterine wall but not the pelvic peritoneum.
The external myometrium may be torn but the laceration does not extend into the body of the uterus

Question 5

What is an incomplete rupture sometimes also called?

Answer 5

Silent rupture

Question 6

What are some causes of a ruptured uterus?

Answer 6

• obstructed labour due to bandls ring
• high parity
• use of oxytocin
• use of prostaglandins
• classical incision for Caesarean section
• trauma : forceps, shoulder dystocia, RTA and assault
• previous scar

Question 7

What happens when bandls ring occurs?

Answer 7

Upper segment thickens and retracts upwards

Below the ring - the lower segment becomes distended, swollen and thins

Question 8

What is bandls rings often mistaken for?

Answer 8

A full bladder

Question 9

Signs and symptoms of a silent / incomplete rupture?

Answer 9

• Develops over an hour or two
• Acute scar tenderness
• Abnormal CTG
• Cessation of contractions
• Fresh red PV loss
• Sudden maternal collapse

Question 10

What is the midwives role in prevention?

Answer 10

• Follow guidelines IOL / augmentation
• Be careful with the use of oxytocics
• Observe women having a VBAC very closely
• Thorough SBAR handover
• Always escalate concerns
• Accurate documentation

Question 11

What are signs of a violent rupture?

Answer 11

• Strong uterine contractions
• Abdo pain with no contractions
• Acute scar tenderness
• PV Bleed
• Maternal tachycardia, shock or collapse
• Fetal brady / absent FH

Question 12

What is the immediate management of a ruptured uterus?

Answer 12

Recognise problem - 2222 - obstetric emergency - state uterine rupture
Brief explanation to woman re. situation
Observations, IV access, x match, fluids (as prescribed)
Assess fetal condition, deliver fetus.

Question 13

What is the post event care that should be given?

Answer 13

• High dependency care
• Regular observations
• Assess blood loss closely
• Support and debrief with parents and MDT
• Datex
• Record keeping
• Future pregnancy advice