Uterine rupture: Difference between revisions
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==Background==
==Background==
Prevalence
[[File:Figure 28 02 01.png|thumb|Normal female anatomy with uterus highlighted.]]
*No prior c-section = 0.01%
[[File:Rupture Tranverse.jpg|thumb|Schematic showing transverse rupture of the anterior uterine wall.]]
*Prior c-section = 0.2-0.8%
[[File:PMC4556862 CRIOG2015-596826.001.png|thumb|Uterine rupture, with extruded amniotic sac seen with abdomen opened.]]
Risk factors
*Spontaneous tearing of the uterus
*Prior c-section (major)
*May result in fetus being expelled into peritoneal cavity.
*Malpresentation
*Occurs in late pregnancy or active labor
*Labor dystocia
*Rare, prevalence:
*[[Hypertension]]
**No prior c-section = 0.01%
*Bicornuate uterus
**Prior c-section = 0.2-0.8%
*Grand multiparity
*Risk factors:
*[[Connective tissue disorder]]
**Prior c-section (major)- rupture most commonly occurs along prior scar lines
*Placenta percreta
**Malpresentation
*Prior myomectomy
**Labor dystocia
*Misoprostol use (oxytocin likely safe)
**[[Hypertension]]
*Typically occurs during labor
**Bicornuate uterus
**Grand multiparity
**[[Connective tissue disorder]]
**Placenta percreta
**Prior myomectomy
**[[Misoprostol]] use (oxytocin likely safe)


==Evaluation==
==Clinical Features==
*Ultrasound
*Persistent [[abdominal pain]] with [[peritonitis|peritoneal signs]]
**Disruption of myometrium
*[[vaginal bleeding in pregnancy (greater than 20wks)|Vaginal bleeding]]
**Free peritoneal fluid (FAST+)
*[[Shock]]
**Anhydramnios/empty uterus
*Palpable uterine defect
**Herniated amniotic sac
*Loss of fetal station
**Fetal anatomy outside of uterus
*Fetal [[bradycardia]] (most suggestive), variable decelerations, evidence of [[hypovolemia]]<ref>https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/uterine-rupture</ref>
**Absence of FHR
*Maternal Clinical
**Persistent abdominal pain with peritoneal signs
**Vaginal bleeding
**Maternal shock
**Loss of fetal station
**Palpable uterine defect


==Differential Diagnosis==
==Differential Diagnosis==
{{VB DDX greater than 20}}
{{VB DDX greater than 20}}
{{Postpartum emergencies DDX}}
==Evaluation==
[[File:PMC5120064 ogs-59-454-g002.png|thumb|Before emergency cesarean section, the fetus was stillborn. Uterine rupture with protrusion of amniotic cavity and placenta, massive hemoperitoneum, and the uterine wall defect (white arrow) are found on abdominal computerized tomography]]
===Workup===
*CBC, chemistry
*Coags
*Type & screen
*Upreg / b-HCG
*Rh
*[[Pelvic ultrasound]]


{{Postpartum emergencies DDX}}
===Diagnosis===
Typically determined by [[pelvic ultrasound]] or (if emergent) OR visualization:
*Disruption of myometrium
*Free peritoneal fluid ([[FAST]]+)
*Anhydramnios/empty uterus
*Herniated amniotic sac
*Fetal anatomy outside of uterus
*Absence of FHR


==Management==
==Management==
*[[Fluid resuscitation]]
*[[Fluid resuscitation]]
*[[Blood product]] replacement
*[[Blood product]] replacement
*[[Emergent delivery]] of fetus
*[[Emergent delivery]] of fetus via cesarean section
 
==Disposition==
*Admission (emergently to operating room)


==See Also==
==See Also==
*[[Postpartum Emergencies]]
*[[Postpartum Emergencies]]
==External Links==


==References==
==References==
<references/>
<references/>


[[Category:OBGYN]]
[[Category:OBGYN]]

Latest revision as of 20:39, 11 December 2024

Background

Normal female anatomy with uterus highlighted.
Schematic showing transverse rupture of the anterior uterine wall.
Uterine rupture, with extruded amniotic sac seen with abdomen opened.
  • Spontaneous tearing of the uterus
  • May result in fetus being expelled into peritoneal cavity.
  • Occurs in late pregnancy or active labor
  • Rare, prevalence:
    • No prior c-section = 0.01%
    • Prior c-section = 0.2-0.8%
  • Risk factors:
    • Prior c-section (major)- rupture most commonly occurs along prior scar lines
    • Malpresentation
    • Labor dystocia
    • Hypertension
    • Bicornuate uterus
    • Grand multiparity
    • Connective tissue disorder
    • Placenta percreta
    • Prior myomectomy
    • Misoprostol use (oxytocin likely safe)

Clinical Features

Differential Diagnosis

Vaginal Bleeding in Pregnancy (>20wks)

3rd Trimester/Postpartum Emergencies

Evaluation

Before emergency cesarean section, the fetus was stillborn. Uterine rupture with protrusion of amniotic cavity and placenta, massive hemoperitoneum, and the uterine wall defect (white arrow) are found on abdominal computerized tomography

Workup

Diagnosis

Typically determined by pelvic ultrasound or (if emergent) OR visualization:

  • Disruption of myometrium
  • Free peritoneal fluid (FAST+)
  • Anhydramnios/empty uterus
  • Herniated amniotic sac
  • Fetal anatomy outside of uterus
  • Absence of FHR

Management

Disposition

  • Admission (emergently to operating room)

See Also

External Links

References

  1. ↑ https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/uterine-rupture
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