Uterine rupture

Question 1

What is uterine rupture?

Answer 1

-complication of labour where myometrium ruptures

Question 2

What is an incomplete rupture or uterine dehiscence?

Answer 2

-perimetrium (serosa) surrounding the uterus remains intact

Question 3

what is a complete rupture?

Answer 3

where the serosa ruptures along with the myometrium, and the contents of the uterus are released into the peritoneal cavity

Question 4

What does uterine rupture lead to?

Answer 4

• significant bleeding
• baby may be released from the uterus into the peritoneal cavity
• has a high morbidity and mortality for both the baby and mother.

Question 5

What is the main risk factor for uterine rupture?

Answer 5

• previous caesarean section
• scar on the uterus becomes a point of weakness, and may rupture with excessive pressure (e.g. excessive stimulation by oxytocin)
• extremely rare for uterine rupture to occur in a patient that is giving birth for the first time

Question 6

What are the other risk factors for uterine rupture?

Answer 6

• Vaginal birth after caesarean (VBAC)
• Previous uterine surgery
• Increased BMI
• High parity
• Increased age
• Induction of labour
• Use of oxytocin to stimulate contractions

Question 7

What does a uterine rupture present with?

Answer 7

• an acutely unwell mother and abnormal CTG
• may occur with induction or augmentation of labour, with signs and symptoms of:

>Abdominal pain
>Vaginal bleeding
>Ceasing of uterine contractions
>Hypotension
>Tachycardia
>Collapse

Question 8

What is the management of uterine rupture?

Answer 8

• is an obstetric emergency
• Resuscitation and transfusion may be required
• Emergency caesarean section is necessary to remove the baby, stop any bleeding and repair or remove the uterus (hysterectomy).