Uterine rupture is rupture of the myometrium in late pregnancy before labor or during labor, which usually occurs in patients with prior uterine surgery (eg, cesarean delivery or myomectomy), but it can occur in an unscarred uterus. It may result in maternal hemorrhage, bladder laceration, or hysterectomy.
Uterine rupture is rare. It can occur during late pregnancy before labor or during labor.
Uterine rupture occurs most often along healed incisions in women who have had prior cesarean deliveries. Other predisposing factors include congenital uterine abnormalities, trauma, and other uterine surgical procedures such as myomectomy or open maternal-fetal surgery.
Causes of Uterine Rupture
Causes of uterine rupture include
Uterine overdistention (due to multifetal pregnancy, polyhydramnios, or fetal anomalies)
External or internal fetal version
Iatrogenic perforation
Excessive use of uterotonics
Failure to recognize labor dystocia with excessive uterine contractions against a lower uterine restriction ring
If women who have had a prior cesarean delivery wish to try vaginal delivery, prostaglandins should not be used because they increase risk of uterine rupture.
Symptoms and Signs of Uterine Rupture
Symptoms and signs of uterine rupture include fetal bradycardia, variable decelerations, evidence of hypovolemia, loss of fetal station (detected during cervical examination), and severe or constant abdominal pain. If the fetus has been expelled from the uterus and is located within the peritoneal cavity, fetal and maternal morbidity and mortality increase significantly.
Diagnosis of Uterine Rupture
Laparotomy
Diagnosis of uterine rupture is confirmed by laparotomy.
Treatment of Uterine Rupture
Laparotomy with cesarean delivery
Hysterectomy, if necessary
Treatment of uterine rupture is immediate laparotomy with cesarean delivery and, if necessary, hysterectomy.
