Uterine Rupture: Symptoms, Causes, Diagnosis, and Management

Uterine rupture is a serious obstetric complication that can be life-threatening for both the mother and the baby. It occurs when the wall of the uterus tears, leading to significant bleeding, pain, and potential damage to surrounding organs.

I. Symptoms

1. Symptoms of Threatened Uterine Rupture:

• Intense, frequent, and painful uterine contractions: These may become less frequent or stop altogether.
• A rigid, tender, and painful uterus: This may be difficult to palpate.
• Bandl-Frommel’s sign: This is a visible sign where the junction between the cervix and the body of the uterus is stretched, creating a distinct ridge.
• Fetal distress: This may include a change in fetal heart rate, such as bradycardia or late decelerations.

2. Symptoms of Uterine Rupture:

• Sudden, severe abdominal pain: This is a hallmark of uterine rupture.
• Heavy vaginal bleeding: The blood will often be bright red.
• Palpable fetal parts in the abdomen: The baby’s limbs or head may be felt through the abdominal wall.
• Signs of hypovolemic shock: These include a rapid heart rate, low blood pressure, pale skin, and excessive sweating.
• Other potential symptoms:
  • Difficulty breathing
  • Nausea and vomiting
  • Dizziness and lightheadedness

II. Causes

Risk factors:

• Previous Cesarean section: Especially if the scar is on the body of the uterus.
• Uterine abnormalities: Such as a bicornuate uterus or a septate uterus.
• Uterine fibroids: Especially large fibroids in the body of the uterus.
• Cephalopelvic disproportion: This occurs when the baby’s head is too large to fit through the mother’s pelvis.
• Multiple pregnancies: Increased risk of uterine rupture with each pregnancy.
• Strong uterine contractions: May be due to factors such as induction of labor, oxytocin administration, or prolonged labor.
• Large baby: This increases the pressure on the uterus.
• Polyhydramnios: An excessive amount of amniotic fluid, putting additional pressure on the uterus.
• Abnormal fetal presentation: For example, a breech presentation or a transverse lie.

Procedural interventions:

• Internal version of a breech baby: This procedure carries a higher risk of uterine rupture.
• Episiotomy: While rare, a very deep episiotomy can potentially extend into the uterus.
• Forceps delivery: Can increase the risk of uterine rupture if used inappropriately.
• Assisted vaginal delivery with vacuum: Similar to forceps delivery, can lead to uterine rupture if not performed correctly.

III. Diagnosis

• Clinical examination: Based on the symptoms and physical findings.
• Pelvic examination: To assess the location and extent of the uterine rupture.
• Ultrasound: To identify the location and extent of the uterine tear, as well as any potential placental abruption.
• Blood tests: To determine the severity of blood loss.
• Urinalysis: To check for kidney function.

IV. Management

Management of threatened uterine rupture:

• Suppression of uterine contractions: Using medications such as tocolytics to reduce contractions.
• Delivery with forceps or vacuum: If the baby is at term and in a favorable position.
• Cesarean delivery: If the baby is not at term or in a favorable position, or if there are signs of fetal distress.
• Close monitoring of the mother and baby’s condition: Regular fetal heart rate monitoring, vital signs monitoring, and assessment for signs of bleeding.

Management of uterine rupture:

• Emergency resuscitation: Including fluid resuscitation, blood transfusions, and medications to raise blood pressure.
• Emergency surgery: To repair the tear, control bleeding, and possibly remove the uterus (hysterectomy).
• Antibiotics: To prevent infection.
• Close monitoring of the mother and baby’s condition: Regular assessment of vital signs, blood loss, and fetal well-being.

V. Prevention

• Careful monitoring of labor: To identify early warning signs of threatened uterine rupture.
• Early diagnosis and management of labor complications: Prompt treatment of factors that could increase the risk of uterine rupture, such as cephalopelvic disproportion.
• Prompt recognition and management of threatened uterine rupture: To reduce the risk of complete rupture.
• Avoiding prolonged labor: Using interventions such as assisted vaginal delivery or Cesarean section if labor progresses too slowly.
• Choosing a healthcare provider with experience in high-risk pregnancies: Ensuring access to timely and appropriate management of labor complications.

VI. Additional Information

• Uterine rupture can occur at different stages of pregnancy, but is most common during labor.
• It can happen once or multiple times.
• The risk of uterine rupture in subsequent pregnancies is higher after a previous rupture.
• Women with a history of Cesarean section should be closely monitored in subsequent pregnancies.

It is crucial to understand the seriousness of uterine rupture and to seek prompt medical attention if any signs or symptoms are present. Early diagnosis and management are essential for ensuring the best possible outcome for both the mother and baby.