image by: Suyash Sonography Centre

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Save of the Month: A Case of Uterine Rupture

Uterine rupture most likely happens in the late third trimester or during active labor when the uterine wall is at its thinnest... 

• Ultrasound your undifferentiated hypotensive patient (RUSH exam – think HI-MAP)
• Have uterine rupture high on your differential for late-term pregnant patients in distress
• Fluid resuscitation and emergent delivery of the fetus is key for both maternal and fetal outcomes

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Previously Featured

Emergency Department Evaluation and Management of Pathologic Obstetric Abdominal Pain

Uterine rupture is an obstetric emergency, and management is surgical intervention for delivery and uterine repair or hysterectomy. Definitive diagnosis can be made at the time of surgical intervention.

EMRounds

Prevalence: No prior c-section = 0.01%, Prior c-section = 0.2-0.8%.

Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health

In conclusion, based on a large multicountry dataset from 29 countries including developing countries, we obtained the incidence of uterine rupture in women with prior CS ranging from 0.2% in high-HDI countries to 1.0% in low-HDI countries. Identified risk factors included giving birth in medium- or low-HDI countries, spontaneous onset of labour, and lower maternal educational level.

Uterine rupture: a preventable obstetric catastrophe

Uterine rupture is a dire emergency with a high incidence of maternal and fetal morbidity and mortality. Skilled attendance with accessible obstetric care, focused antenatal care, strict intrapartum monitoring and good surgical approach are key elements for the prevention and management of uterine rupture.

What Is a Uterine Rupture and How Often Does It Occur?

ACOG states that the overwhelming majority of women who labor after a prior cesarean have a safe and normal birth. The risk for a uterine rupture with one prior horizontal uterine scar is about 1 in 200 women who labor for a VBAC.

Resources

StatPearls

Within pregnant women, there are two populations at risk for uterine rupture: those who have a myometrial scar from previous surgery and those with an unscarred uterus. The cause and risk factors for each group are different.

TeachMe ObGyn

It is a rare complication, but one that is associated with significant maternal and fetal morbidity and mortality.

WikEM

Spontaneous tearing of the uterus. May result in fetus being expelled into peritoneal cavity. Occurs in late pregnancy or active labor.