Uterine rupture

2 types
(I) Uterine dehisence-separation of a preexisting scar without the disruption of parietal peritoneum.
(II)uterine rupture-full thickness disruption of uterine wall.

Risk factors

(I)previous caesarean section(Classical &Lower segment)
(II)Previous uterine surgery-myomectomy
(III)Grand multi parity
(IV)oxytocin
(V)prostaglandins

Clinical features

Uterine dehisence could be asymptomatic
(I)continuous lower abdominal pain
(II)fetal distress
(III)receding presenting part in labour
(IV)loss of uterine contractility during labour
(V) Haematuria/Bleeding per vaginum
(VI)Maternal tachycardia & hypo tension are late signs

Stair case sign-stepwise gradual decrease in contraction amplitude has been reported in uterine rupture.


Treatment

This is an Obstetrics emergency

resuscitation & surgery should go hand in hand.
call for Senior help(Obstetrician & Anaesthetist)
IV access
Arrange Cross matching of Blood(6-10 units)
Allocate one person to scribe the events
Keep the family informed during the procedure
Debrief at the end of procedure


If uterine rupture occurs prior to delivery emergency caesarean section should be done.
The following options can be selected according type of tear,state of the patient and  ongoing blood loss.
(I)uterine repair
(II)Hysterectomy
(III)Internal artery ligation



Powerpoint on uterine rupture
References
(I)E Medicine
(II)Successful management of gravid uterine rupture.Taiwan J Obstet Gynecol. 2009 Sep;48(3):319-20.Authors: Fu PT Chen CH Wu GJ Yu MH.PMID: 19797032 [PubMed - indexed for MEDLINE]
(III)Spontaneous uterine rupture-Case report and  review