Uterine rupture Flashcards
What is uterine rupture
Full thickness disruption of the uterine muscle and overlying serosa
When does uterine rupture typically occur?
During labour
What can uterine rupture extend to affect?
Bladder or broad ligament
What are the two main types of uterine rupture?
Incomplete
Complete
What is an incomplete rupture?
Where the peritoneum overlying the uterus is intact - uterine contents remain in the uterus
What is complete rupture?
Peritoneum is torn
Uterine contents can escape into peritoneal cavity
List the risk factors for uterine rupture
Previous c-section - classical (vertical incisions) carry most risk Previous uterine surgery Induction Obstruction of labour Multiple pregnancy Multiparity
Describe the clinical features of uterine rupture
Non-specific
Severe abdominal pain persisting between contractions
Shoulder tip pain - diaphragmatic irritation
Vaginal bleeding
Describe features on examination of uterine rupture
Regression of presenting part
Scar tenderness on abdominal palpation
Palpable foetal parts
Hypovolaemic shock - tachycardia and hypotension in major haemorrhage
CTG - foetal distress or absent heart sounds
What are the differentials of uterine rupture?
Placental abruption
Placenta praevia
Vasa praevia
What investigations should be done in uterine rupture?
CTG - changes in heart rate pattern and prolonged foetal bradycardia are indicators
Maternal haematuria on catheterisation
US in the prelabour setting - abnormal lie/presnetation, haemoperitoneum, absent uterine wall
Describe the management of uterine rupture
ABCDE approach
Massive obstetric haemorrhage protocol
2222 - obstetric and neonatal emergency
Protect airway
15L of 100% oxygen through non rebreathe mask
Assess circulatory compromise - 2 large bore cannulas and blood samples, circulatory resuscitation, assess GCS
Expose patient to identify other bleeding points
Delivery via caesarean section and uterus is either repaired or removed
What is the decision-incision interval of uterine rupture?
<30mins
