Uterine rupture: Difference between revisions
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*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== | ||
Revision as of 09:07, 9 September 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
- 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
Disposition
- Admission (emergently to operating room)