Uterine rupture

Question 1

Define

Answer 1

1. Rupture of the uterine cavity

2. Rupture of fetal membranes

Question 2

Risk factors

Answer 2

1. previous C section (+for classical,
less in LSCS)
2. multi, 
3. +age
4. Placentation
5. Angular pregnancy
6. Over-distension
7. Gestation >40 weeks
8. Mole
9. Uterine trauma
10. Oxytocin
11. Instrumental abortion
12. Uterine anomalies

Question 3

Clinical features

Answer 3

1. Abdominal pain, tearing, rigidity
2. Bleeding
3. Vitals->hypoT, tachyC, tachyp
4. Fetal distress, HR abnormality
5. Palpable fetal parts
6. Cessation of contractions

Question 4

Complications

Answer 4

1. Fetal hypoxia, acidosis, death, cerebral palsy, neurological impairment
2. Intensive care
3. Severe maternal blood loss
4. Hypovolemic shock
5. Bladder injury
6. Need for hysterectomy
7. Maternal death

Question 5

Management

Answer 5

1. ABC, AMPLE
2. IV access, IVF, bloods, catheter
3. Call consultant, theatre, anaesthetics->prep for surgery
4. Investigations: FBC, UEC, coags, GH and cross match
5. Consent for surgery +/- hysterectomy if repair cannot be done
6. Consider transfusion if need
7. Analgesia, antiemetic
8. Laparotomy, delivery, repair, hysterectomy