Uterine rupture: Difference between revisions
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==Background== | ==Background== | ||
[[File:Figure 28 02 01.png|thumb|Normal female anatomy with uterus highlighted.]] | |||
[[File:Rupture Tranverse.jpg|thumb|Schematic showing transverse rupture of the anterior uterine wall.]] | |||
[[File:PMC4556862 CRIOG2015-596826.001.png|thumb|Uterine rupture, with extruded amniotic sac seen with abdomen opened.]] | |||
*Spontaneous tearing of the uterus | *Spontaneous tearing of the uterus | ||
*May result in fetus being expelled into | *May result in fetus being expelled into peritoneal cavity. | ||
*Occurs in late pregnancy or active labor | *Occurs in late pregnancy or active labor | ||
*Rare, prevalence: | *Rare, prevalence: | ||
| Line 24: | Line 27: | ||
*Palpable uterine defect | *Palpable uterine defect | ||
*Loss of fetal station | *Loss of fetal station | ||
*Fetal [[bradycardia]], variable decelerations, evidence of [[hypovolemia]]<ref>https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/uterine-rupture</ref> | *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> | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 31: | Line 34: | ||
==Evaluation== | ==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]] | *[[Pelvic ultrasound]] | ||
===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
- 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
- Persistent abdominal pain with peritoneal signs
- Vaginal bleeding
- Shock
- Palpable uterine defect
- Loss of fetal station
- Fetal bradycardia (most suggestive), variable decelerations, evidence of hypovolemia[1]
Differential Diagnosis
Vaginal Bleeding in Pregnancy (>20wks)
- Emergent delivery
- Placental abruption
- Placenta previa
- Vasa previa
- Uterine rupture
- Preterm labor
- Vaginal trauma
- Placenta accreta
- Intrauterine fetal demise
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Evaluation
Workup
- CBC, chemistry
- Coags
- Type & screen
- Upreg / b-HCG
- Rh
- Pelvic ultrasound
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
- Fluid resuscitation
- Blood product replacement
- Emergent delivery of fetus via cesarean section
Disposition
- Admission (emergently to operating room)