Pregnancy brings numerous joys to a couple but there is no denying that as any health condition, it also brings along with it certain risks. One such risk is a uterine rupture.
So, what is a uterine rupture?
A uterine rupture is nothing but the spontaneous tearing of the uterus that results in the fetus being expelled into the peritoneal cavity.
In simple terms, it is nothing but the tearing of the muscular wall of the uterus during pregnancy or childbirth.
What are the types of uterine rupture?
There are mainly two types:
- An incomplete rupture: In which the peritoneum remains intact.
- A complete rupture: In which the contents of the uterus spill into the peritoneal cavity (or to the broad ligament).
In most instances, the occurrence of a uterine rupture is rare. Even if it does occur, it happens during:
- late pregnancy
- active labor
- prior cesarean delivery (along with the healed scar lines)
Along with the above-mentioned reasons, there are other predisposing factors which lead a uterine rupture, these include:
- trauma (directly/indirectly to the uterus)
- congenital uterine abnormalities
- uterine surgical procedures (myomectomies, open fetal surgery, etc)
What are the causes of a uterine rupture?
The common reasons for a uterine rupture to be seen in a pregnancy include:
- External/internal fetal version
- Failure in recognizing labor dystocia with excessive uterine contractions
- Uterine overdistention
- Iatrogenic perforation
- Excessive use of uterotonics
- Use of prostaglandins during a vaginal delivery following a prior C-section birth aka VBAC (vaginal birth after cesarean section)
It is said that the cardinal sign of uterine rupture is the loss of fetal station when discovered on a manual vaginal/cervical examination.
The signs and symptoms include:
In the mother:
- old cesarean scar undergoing dehiscence
- abdominal pain (severe and constant)
- vaginal bleeding (moderate to severe)
- intraabdominal bleeding leading to hypovolemic shock
- falling blood pressure (a late sign of increased bleeding)
In most instances, the abdominal pain and vaginal bleeding are not suggestive of a uterine rupture as they are seen in a normal delivery as well.
In the baby:
- loss of fetal station
- fetal bradycardia
- variable decelerations
What are the complications of a uterine rupture?
To the mother:
In some cases, there is a chance maternal death due to the blood loss and hypovolemic shock. In the present day, due to scientific advancement, the rate of maternal mortality has been reduced to <1%.
To the baby:
If the fetus has been expelled from the uterine sac and is now located within the peritoneal cavity, it may increase the mortality and morbidity.
How do you diagnose a uterine rupture?
Most often, the uterine rupture is confirmed and diagnosed by a laparotomy.
What is the treatment of a uterine rupture?
A uterine rupture in most often managed with an emergency exploratory laparotomy accompanied with a cesarean delivery. Blood and fluid transfusion are done in the majority of the cases. After assessing the nature of the rupture and the status of the mother, the uterus is either:
- removed (cesarean hysterectomy)
All the above interventions are done in order to see that the mother and child are both safe and risk-free.