Uterine rupture

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

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

See Also

• Postpartum Emergencies