uterine rupture

Question 1

uterine rupture has increased due to use of

Answer 1

labor induction and augmentation

Question 2

vertical or classical uterine scars are more likely to

Answer 2

rupture (33% do so before labor)- can result in hemorrhage

Question 3

transverse scars are more likely to

Answer 3

dehisce- can extend into uterine vessels and cause hemorrhage

Question 4

complications of transverse scar dehiscence

Answer 4

prolapse of umbilical cord through the ruptured uterine wall
fetus and placenta may make their way into the abdomen
50-70% fetal mortality rate with rupture and expulsion into the abdomen

Question 5

risk factors for uterine rupture

Answer 5

uterin overdistention- polyhdyramnios, macrosomia, multip

dystocia

Question 6

ssx in general

Answer 6

sudden severe FHR decels (most reliable)

intrauterine pressure catheter may lose pressure

Question 7

ssx of upper segment rupture

Answer 7

Very severe sharp, tearing pain
Faintness or actual collapse
Either vaginal bleeding or signs and symptoms of internal bleeding, possibly including shoulder-tip pain
Loss of fetal station
Change of dilation
Likely fetal demise
May palpate fetus separately in abdomen from uterus

Question 8

ssx of lower segment rupture

Answer 8

Ache or pain in the lower abdomen- even up to shoulder also
UC either decrease or cease
Less bleeding due to less vascularity of lower uterine segment
Fetal distress seen
Diagnosis may not be made often till repeat C- section, manual removal of placenta, hysterectomy for post partum hemorrhage
May see hemorrhage resolve as the blood fills the broad ligament causing a hematoma. Will see patient continue to decline despite seemingly lack of vaginal bleeding

Question 9

treatment

Answer 9

Administer O2 and place mother in left lateral tilt position
Type and crossmatch blood
Treat shock and prepare for possible hysterectomy
Usually C-section to save the baby
Antibiotic therapy administered after delivery
Usually hysterectomy or possibly uterine repair