Uterine rupture: Difference between revisions
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==Background==
==Background==
*Previous C-section is primary risk factor
[[File:Figure 28 02 01.png|thumb|Normal female anatomy with uterus highlighted.]]
*Attempting VBAC
[[File:Rupture Tranverse.jpg|thumb|Schematic showing transverse rupture of the anterior uterine wall.]]
*Cocaine use
[[File:PMC4556862 CRIOG2015-596826.001.png|thumb|Uterine rupture, with extruded amniotic sac seen with abdomen opened.]]
*Trauma
*Spontaneous tearing of the uterus
*Multigestational
*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)


==Diagnosis==
==Clinical Features==
*Mother
*Persistent [[abdominal pain]] with [[peritonitis|peritoneal signs]]
**Persistent abdominal pain
*[[vaginal bleeding in pregnancy (greater than 20wks)|Vaginal bleeding]]
**Vaginal bleeding
*[[Shock]]
**Loss of fetal station
*Palpable uterine defect
**Palpable uterine defect
*Loss of fetal station
*Fetus
*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>
**Bradycardia


==Differential Diagnosis==
==Differential Diagnosis==
{{VB DDX greater than 20}}
{{VB DDX greater than 20}}
{{Postpartum emergencies DDX}}


{{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]]
 
===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]]


==Source==
==External Links==
Tintinalli
 
==References==
<references/>


[[Category:OB/GYN]]
[[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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