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 uterus
• • Abdominal pain or pain over previous
c/s scar
• • Abnormalities of the fetal heart rate
and pattern
• • Vaginal bleeding
• • Maternal tachycardia
• • Poor 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.