Uterine rupture
Background
Prevalence
- No prior c-section = 0.01%
- Prior c-section = 0.2-0.8%
Risk factors
- Prior c-section (major)
- Malpresentation
- Labor dystocia
- Hypertension
- Bicornuate uterus
- Grand multiparity
- Connective tissue disorder
- Placenta percreta
- Prior myomectomy
- Misoprostol use (oxytocin likely safe)
- Typically occurs during labor
Diagnosis
- Ultrasound: abdominal free fluid, uterine defect
- Maternal Clinical
- Persistent abdominal pain with peritoneal signs
- Vaginal bleeding
- Maternal shock
- Loss of fetal station
- Palpable uterine defect
- Fetus
- Bradycardia
- Fetal heart decels
- Fetal demise
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
Management
- Fluid resuscitation
- Blood product replacement
- Emergent delivery of fetus
See Also
Source
Tintinalli