Uterine rupture: Difference between revisions
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==Background== | ==Background== | ||
*Spontaneous tearing of the uterus | |||
*No prior c-section = 0.01% | *May result in fetus being expelled into peritoneal cavity may result in the fetus being expelled into the peritoneal cavity. | ||
*Prior c-section = 0.2-0.8% | *Occurs in late pregnancy or active labor | ||
Risk factors | *Rare, prevalence: | ||
*Prior c-section (major) | **No prior c-section = 0.01% | ||
*Malpresentation | **Prior c-section = 0.2-0.8% | ||
*Labor dystocia | *Risk factors: | ||
*[[Hypertension]] | **Prior c-section (major)- rupture most commonly occurs along prior scar lines | ||
*Bicornuate uterus | **Malpresentation | ||
*Grand multiparity | **Labor dystocia | ||
*[[Connective tissue disorder]] | **[[Hypertension]] | ||
*Placenta percreta | **Bicornuate uterus | ||
*Prior myomectomy | **Grand multiparity | ||
*Misoprostol use (oxytocin likely safe) | **[[Connective tissue disorder]] | ||
* | **Placenta percreta | ||
**Prior myomectomy | |||
**[[Misoprostol]] use (oxytocin likely safe) | |||
==Clinical Features== | |||
*Persistent [[abdominal pain]] with [[peritonitis|peritoneal signs]] | |||
*[[vaginal bleeding in pregnancy (greater than 20wks)|Vaginal bleeding]] | |||
*[[Shock]] | |||
*Palpable uterine defect | |||
*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> | |||
==Differential Diagnosis== | |||
{{VB DDX greater than 20}} | |||
{{Postpartum emergencies DDX}} | |||
==Evaluation== | ==Evaluation== | ||
* | *[[Pelvic ultrasound]] | ||
**Disruption of myometrium | **Disruption of myometrium | ||
**Free peritoneal fluid (FAST+) | **Free peritoneal fluid ([[FAST]]+) | ||
**Anhydramnios/empty uterus | **Anhydramnios/empty uterus | ||
**Herniated amniotic sac | **Herniated amniotic sac | ||
**Fetal anatomy outside of uterus | **Fetal anatomy outside of uterus | ||
**Absence of FHR | **Absence of FHR | ||
==Management== | ==Management== | ||
Revision as of 18:34, 4 October 2019
Background
- Spontaneous tearing of the uterus
- May result in fetus being expelled into peritoneal cavity may result in the fetus being expelled into the 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, 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
- Pelvic ultrasound
- 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