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

Evaluation

  • Ultrasound
    • Disruption of myometrium
    • Free peritoneal fluid (FAST+)
    • Anhydramnios/empty uterus
    • Herniated amniotic sac
    • Fetal anatomy outside of uterus
    • Absence of FHR
  • Maternal Clinical
    • Persistent abdominal pain with peritoneal signs
    • Vaginal bleeding
    • Maternal shock
    • Loss of fetal station
    • Palpable uterine defect

Differential Diagnosis

Vaginal Bleeding in Pregnancy (>20wks)

Postpartum Emergencies

Management

See Also

References