Uterine rupture

Background

• Previous C-section is primary risk factor
• Attempting VBAC
• Cocaine use
• Trauma
• Multigestational

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

• Postpartum Emergencies

Source

Tintinalli