Uterine rupture

A serious childbirth complication

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Uterine rupture is a serious obstetric complication where the muscular wall of the uterus tears during pregnancy or childbirth. This condition can lead to severe maternal and fetal morbidity and mortality if not promptly diagnosed and managed.

Pathophysiology

Uterine rupture typically occurs during labor and is often associated with a previous cesarean section scar. The rupture can be complete, involving all layers of the uterine wall, or incomplete, where the peritoneum remains intact. The most common site for rupture is the lower uterine segment.

Risk Factors

Several factors increase the risk of uterine rupture, including:

• Previous cesarean delivery
• Induction of labor with oxytocin or prostaglandins
• High parity (having given birth multiple times)
• Trauma to the uterus
• Congenital uterine anomalies

Clinical Presentation

The symptoms of uterine rupture can vary but often include:

• Sudden onset of abdominal pain
• Vaginal bleeding
• Loss of fetal station
• Abnormal fetal heart rate patterns
• Maternal tachycardia and hypotension

Diagnosis

Diagnosis is primarily clinical, supported by ultrasound findings. In some cases, a sudden change in the fetal heart rate pattern may be the first indication of a rupture.

Management

Immediate surgical intervention is required to manage uterine rupture. This typically involves an emergency laparotomy and repair of the uterine defect or hysterectomy if repair is not feasible. Rapid delivery of the fetus is crucial to minimize fetal and maternal complications.

Prognosis

The prognosis depends on the speed of diagnosis and intervention. Prompt surgical management can significantly reduce the risk of severe outcomes for both the mother and the fetus.

Prevention

Preventive strategies include careful monitoring of labor in women with a history of cesarean delivery and avoiding unnecessary induction of labor. Elective repeat cesarean delivery may be recommended for women at high risk of rupture.

Related pages

• Cesarean section
• Labor (childbirth)
• Obstetrics
• Maternal health

Illustration of a transverse uterine rupture