Uterine rupture
Encyclopedia
Uterine rupture is a potentially catastrophic event during childbirth
by which the integrity of the myometrial
wall is breached. In an incomplete rupture the peritoneum
is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament. A uterine rupture is a life-threatening event for mother and baby.
A uterine rupture typically occurs during early labor, but may already develop during late pregnancy.
Uterine dehiscence
is a similar condition, but involves fewer layers, less bleeding, and less risk.
), dysfunctional labor, labor augmentation by oxytocin
or prostaglandins, and high parity
may also set the stage for uterine rupture. In 2006, an extremely rare case of uterine rupture in a first pregnancy with no risk factors was reported.
, but with further labor, the woman may experience abdominal pain and vaginal bleeding. Often a deterioration of the fetal heart rate is a leading sign. Intra-abdominal bleeding can lead to hypovolemic shock and death.
with cesarean delivery accompanied by fluid and blood transfusion
are indicated for the management of uterine rupture. Depending on the nature of the rupture and the condition of the patient the uterus may be either repaired or needs to be removed (cesarean hysterectomy).
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
by which the integrity of the myometrial
Myometrium
The myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells , but also of supporting stromal and vascular tissue...
wall is breached. In an incomplete rupture the peritoneum
Peritoneum
The peritoneum is the serous membrane that forms the lining of the abdominal cavity or the coelom — it covers most of the intra-abdominal organs — in amniotes and some invertebrates...
is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament. A uterine rupture is a life-threatening event for mother and baby.
A uterine rupture typically occurs during early labor, but may already develop during late pregnancy.
Uterine dehiscence
Dehiscence
Dehiscence can refer to:*Dehiscence is the spontaneous opening at maturity of a plant structure, such as a fruit, anther, or sporangium, to release its contents.*Wound dehiscence is a previously closed wound reopening....
is a similar condition, but involves fewer layers, less bleeding, and less risk.
Risk factors and causes
A uterine scar from a previous cesarean section is the most common risk factor. (In one review, 52% had previous cesarean scars.) Other forms of uterine surgery that result in full-thickness incisions (such as a myomectomyMyomectomy
Myomectomy, sometimes also fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential.-Indications:...
), dysfunctional labor, labor augmentation by oxytocin
Oxytocin
Oxytocin is a mammalian hormone that acts primarily as a neuromodulator in the brain.Oxytocin is best known for its roles in sexual reproduction, in particular during and after childbirth...
or prostaglandins, and high parity
Parity (medicine)
In biology, parity is a technical term that refers to the number of times a female has given birth to a fetus.It can lead to some ambiguity for events occurring between 20 and 24 weeks, and for multiple pregnancies.-Enumeration:...
may also set the stage for uterine rupture. In 2006, an extremely rare case of uterine rupture in a first pregnancy with no risk factors was reported.
Presentation
Symptoms of a rupture may be initially quite subtle. An old cesarean scar may undergo dehiscenceDehiscence
Dehiscence can refer to:*Dehiscence is the spontaneous opening at maturity of a plant structure, such as a fruit, anther, or sporangium, to release its contents.*Wound dehiscence is a previously closed wound reopening....
, but with further labor, the woman may experience abdominal pain and vaginal bleeding. Often a deterioration of the fetal heart rate is a leading sign. Intra-abdominal bleeding can lead to hypovolemic shock and death.
Treatment
Emergency exploratory laparotomyLaparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
with cesarean delivery accompanied by fluid and blood transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
are indicated for the management of uterine rupture. Depending on the nature of the rupture and the condition of the patient the uterus may be either repaired or needs to be removed (cesarean hysterectomy).
Signs and symptoms
- Abdominal painAbdominal painAbdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...
and tenderness. The pain may not be severe; it may occur suddenly at the peak of a contraction. The woman may describe a feeling that something "gave way" or "ripped." - Chest painChest painChest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.-Differential...
, pain between the scapulae, or pain on inspiration—Pain occurs because of the irritation of blood below the woman's diphragm - Hypovolemic shock caused by hemorrhage—Falling blood pressure, tachycardiaTachycardiaTachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
, tachypnea, pallor, cool and clammy skin, and anxiety. The fall in blood pressure is often a late sign of hemorrhage - Signs associated with fetal oxygenation, such as late decelerations, reduced viability, tachycardia, and bradycardia
- Absent fetal heart sounds with a large disruption of the placenta; absent fetal heart activity by ultrasound examination
- Cessation of uterine contractions
- Palpation of the fetus outside the uterus (usually occurs only with a large, complete rupture). The fetus is likely to be dead