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[1]
Differential Diagnosis
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
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