Uterine Rupture Deepa Mishra Assistant Professor (OBG) Introduction Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present. Disability or death of the mother or baby may result. Definition Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus. Incidence Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9% Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.  In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000 Risk of death of the baby is about 6% Etiology Risk Factors Previous cesarean section Myomectomy Dysfunctional labor Labor augmentation by oxytocin or prostaglandins High parity First pregnancy- very rare Types of uterine rupture Complete Rupture All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity. Usually results in death Incomplete Rupture Visceral peritoneum is intact and usually the fetus remains in the uterine cavity Sign & Symptoms Uterine dehiscence and abdominal pain and vaginal bleeding Deterioration of fetal heart rate Loss of fetal station on manual vaginal exam Hypovolemic shock due to intrabdominal bleeding Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum Cessation of uterine contractions Palpation of fetus outside the uterus Signs of abdominal pregnancy Post term pregnancy Diagnosis Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring Absent fetal heart sound On PV hot, dry vagina with a large caput over the presenting part Prevention Early diagnosis and management of CPD mal presentation and obstructed labor Proper selection of cases for vaginal delivery Carefull monitoring of oxytocin infusion specially in multipara Avoid intra uterine manipulation no version in single fetus Instrumental delivery after cervical dilatation Immediate CS in obstructed labor Hospital delivery for high risk cases ECV should be avoided during general anaesthesia Careful manual removal of placenta Treatment Resuscitation with adequate hydration and blood transfusion Laprotomy Hysterectomy Repair Complication Rupture uterus with haemorrhage, shock and sepsis Fetal loss is high in spontaneous and traumatic rupture Mortality is low in LSCS scar rupture

1. UTERINE RUPTURE
Deepa Mishra
Assistant Professor (OBG)

2. Introduction
• Uterine rupture is when
the muscular wall of the
uterus tears during
pregnancy or childbirth
• Symptoms while
classically including
increased pain, vaginal
bleeding, or a change in
contractions are not
always present.
• Disability or death of the
mother or baby may
result.

3. Definition
• Uterine rupture is giving way of gravid uterus or
dissolution in the continuity of uterine wall anytime after
28 weeks of gestation with or without expulsion of the
fetus.

4. Incidence
• Rates of uterine rupture during vaginal birth following one
previous C-section, done by the typical technique, are
estimated at 0.9%
• Rates are greater among those who have had multiple
prior C-sections or an atypical type of C-section.
• In those who do have uterine scarring, the risk during a
vaginal birth is about 1 per 12,000
• Risk of death of the baby is about 6%

5. Etiology

6. Risk Factors
• Previous cesarean section
• Myomectomy
• Dysfunctional labor
• Labor augmentation by oxytocin or prostaglandins
• High parity
• First pregnancy- very rare

7. Types of uterine rupture
• Complete Rupture
• All the layers including peritoneum are torn and the uterine
contents escape into the peritoneal cavity.
• Usually results in death
• Incomplete Rupture
• Visceral peritoneum is intact and usually the fetus remains in the
uterine cavity

8. Sign & Symptoms
• Uterine dehiscence and abdominal pain and vaginal
bleeding
• Deterioration of fetal heart rate
• Loss of fetal station on manual vaginal exam
• Hypovolemic shock due to intrabdominal bleeding
• Chest pain between the scapulae, pain during inspiration
due to irritation of blood below the perineum
• Cessation of uterine contractions
• Palpation of fetus outside the uterus
• Signs of abdominal pregnancy
• Post term pregnancy

9. Diagnosis
• Signs of obstructed labor with dehydration, exhaustion,
tachycardia raised temperature tonic contraction ,
pathological retraction ring
• Absent fetal heart sound
• On PV hot, dry vagina with a large caput over the
presenting part

10. Prevention
• Early diagnosis and management of CPD mal
presentation and obstructed labor
• Proper selection of cases for vaginal delivery
• Carefull monitoring of oxytocin infusion specially in
multipara
• Avoid intra uterine manipulation no version in single fetus
• Instrumental delivery after cervical dilatation
• Immediate CS in obstructed labor
• Hospital delivery for high risk cases
• ECV should be avoided during general anaesthesia
• Careful manual removal of placenta

11. Treatment
• Resuscitation with adequate hydration and blood
transfusion
• Laprotomy
• Hysterectomy
• Repair

12. Complication
• Rupture uterus with haemorrhage, shock and sepsis
• Fetal loss is high in spontaneous and traumatic rupture
• Mortality is low in LSCS scar rupture