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

Differential Diagnosis

Vaginal Bleeding in Pregnancy (>20wks)

3rd Trimester/Postpartum Emergencies

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

See Also

References