Rupture of the uterus

• -the most serious complications in midwifery and obstetrics.

• -It is often fatal for the fetus and may also be responsible for the death of the mother.

• - It remains a significant problem worldwide. With effective antenatal and intrapartum care some cases may be avoided.

• Rupture of the uterus is defined as being • 1-complete • 2-incomplete:

• • complete rupture involves a tear in the wall of the uterus with or without expulsion of the fetus

• • incomplete rupture involves tearing of the uterine wall but not the perimetrium.

• -Dehiscence of an existing uterine scar may also occur.

• - This involves rupture of the uterine wall but the fetal membranes remain intact.

• - The fetus is retained within the uterus and not expelled into the peritoneal cavity

Causes

• - spontaneous rupture of an unscarred uterus in primigravid mothers but are rare.

• Precipitating factors;• • antenatal rupture of the uterus, where there

has been a history of previous classical caesarean section

• • neglected labour, where there is previous history of caesarean section

• • high parity• • use of oxytocin, particularly where the

mother is of high parity• • use of prostaglandins to induce labour, in the

presence of an existing scar

• obstructed labour: the uterus ruptures owing to excessive thinning of the lower segment

• • extension of severe cervical laceration upwards into the lower uterine segment

• -the result of trauma during an assisted birth •

• -trauma, as a result of a blast injury or an accident

• • perforation of the non-pregnant uterus can result in rupture of the uterus in a subsequent pregnancy

Signs of intrapartum rupture of the uterus

• -Complete rupture of a previously non-scarred uterus may be accompanied by sudden collapse of the mother, who complains of:

• 1- severe abdominal pain. • 2-The maternal pulse rate increases; • 3- alterations of the fetal heart may occur,

including the presence of variable decelerations

• 4- intrapartum fetal deaths associated with ruptured uterus

• 5-There may be evidence of fresh vaginal bleeding.

• 6- The uterine contractions may stop and the contour of the abdomen alters.

• 7-The fetus becomes palpable in the abdomen as the presenting part regresses.

• 8-The degree and speed of the mother's collapse and shock depend on the extent of the rupture and the blood loss

• Signs of rupture of uterusSigns of rupture of uterus• •• Abdominal pain or pain over Abdominal pain or pain over

previous c/s scarprevious c/s scar• •• Abnormalities of the fetal heart Abnormalities of the fetal heart

rate and patternrate and pattern• •• Vaginal bleedingVaginal bleeding• •• Maternal tachycardiaMaternal tachycardia• •• Poor progress in labourPoor progress in labour

Incomplete rupture of the uterus• have an insidious onset• found only after birth or during a caesarean section. • This type is more commonly associated with previous

caesarean section. • Blood loss associated with dehiscence, or incomplete

rupture, can be scanty, as the rupture occurs along the fibrous scar tissue which is avascular

• shock during the third stage of labour is severe • the mother fails to respond to treatment given,• Incomplete rupture may also be manifest as a cause

of abdominal pain and or postpartum hemorrhage following vaginal birth.

Management

• -An immediate caesarean section is performed in the hope of delivering a live baby.

• - Following the birth of the baby and placenta, the extent of the rupture can be assessed.

• -Choice between the options to perform a hysterectomy or to repair the rupture depends on the extent of the trauma and the mother's condition.

• -Further clinical assessment will include evaluation of the need for blood replacement and management of any shock.

• -The mother will be unprepared for the events that have occurred and therefore may be totally opposed to hysterectomy.

• -Reports of successful pregnancy following repair of uterine rupture are available

Rupture of the uterus following previous caesarean section

• -The risk of uterine rupture is increased for those women who have a uterine scar.

• - Rates of rupture are lowest following a lower segment caesarean section.