Uterine Rupture

Question 1

When do most uterine ruptures occur?

Answer 1

during labor

Question 2

A prior uterine scar is associated with ___% of all uterine ruptures?

Answer 2

90%

Question 3

What is the primary maternal complications?

Answer 3

hemorrhage and hypovolemic shock

Question 4

Epidemiology of uterine rupture

Answer 4

Pts. with no prior uterine surgery: 1 in 15000 / 1 in 20000

Prior low transverse C-S: 0.5-0.1% of deliveries

Prior classical C-S: 6-12%

Question 5

Risk factors for uterine rupture

Answer 5

Prior uterine surgery/scar
Oxytocin overuse
Grand multiparity
Marked uterine distension
Abnormal fetal lie
Large fetus
External version
Trauma

Question 6

Clinical manifestation of Uterine Rupture

Answer 6

Sudden onset intense abdominal pain
Variable vaginal bleeding (can be spotting, can be severe hemorrhage)
Non-reassuring fetal testing
Abnormal abdominal contour
Cessation of uterine contractions
No fetal heart tones
Regression of fetal presenting part

Question 7

Treatment of Uterine Rupture

Answer 7

Immediate laparotomy and delivery of fetus.
If possible, repair rupture site and obtain hemostasis.
Possible hysterectomy.
C-Sections for subsequent pregnancies –> Repeat C-S at 36 wks after confirmation of lung maturity