Uterine rupture

Last updated: November 21, 2022

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Uterine rupture is a pregnancy complication that is life-threatening for the mother and the baby. It occurs in approximately one in every 4000 births and, in most cases, during labor. This condition is caused by gross uterine distention or uterine scarring; patients who have had a cesarean delivery in a previous pregnancy are particularly prone to uterine rupture. Signs and symptoms may vary depending on the location and the extent of the rupture. A sudden pause in contractions takes place after rupture, along with an abnormal fetal heart rate (usually bradycardia), severe abdominal pain, vaginal bleeding, and hemodynamic instability. Women with this condition must undergo laparotomy and emergency cesarean delivery. If the uterus is severely damaged and cannot be repaired, or the bleeding is refractory, hysterectomy is necessary.

Epidemiological data refers to the US, unless otherwise specified.

Uterine rupture is primarily caused by uterine distention. Theoretically, this can occur at any stage of pregnancy; however, it usually takes place during active labor because of the massive force exerted during contractions. [3][4][5]

Signs of imminent uterine rupture [7]

  • Severe abdominal pain
  • Increased contractions followed by hyperactive labor
  • Bandl ring: muscular ring that can be seen above the belly button due to the powerful contractions of the upper uterine segment

Signs of uterine rupture [3][7][8]

Uterine rupture generally occurs during active labor. However, a third of uterine ruptures occur prior to the onset of labor. [8][9]

If clinical suspicion is high, do not delay emergency cesarean delivery for confirmatory imaging. [8][9]

See “Differential diagnosis of antepartum bleeding.”

The differential diagnoses listed here are not exhaustive.

All patients with uterine rupture or imminent rupture require immediate laparotomy with emergency cesarean delivery within 30 minutes. [8]

Uterine dehiscence

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  2. Uterine Rupture. https://www.npeu.ox.ac.uk/ukoss/current-surveillance/ur#r6. Updated: December 9, 2014. Accessed: January 2, 2017.
  3. Augustin G. Acute Abdomen During Pregnancy. Springer ; 2014
  4. Carr PL, Ricciotti HA, Freund KM, Kahan S. In a Page OB/GYN & Women's Health . Blackwell Publishing ; 2003
  5. National Institutes of Health Consensus Development Conference. National Institutes of Health Consensus Development Conference Statement: Vaginal Birth After Cesarean: New Insights March 8-10, 2010. Seminars in Perinatology. 2010; 34 (4): p.293-307. doi: 10.1053/j.semperi.2010.05.001 . | Open in Read by QxMD
  6. Al-Zirqi I, Daltveit AK, Forsén L, Stray-Pedersen B, Vangen S. Risk factors for complete uterine rupture. Am J Obstet Gynecol. 2016; 216 (2): p.165.e1-165.e8. doi: 10.1016/j.ajog.2016.10.017 . | Open in Read by QxMD
  7. Padumadasa S, Goonewardene M. Obstetric Emergencies. CRC Press ; 2021
  8. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  9. Toppenberg KS, Block WA Jr. Uterine rupture: what family physicians need to know.. Am Fam Physician. 2002; 66 (5): p.823-8.
  10. Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014; 210 (3): p.179-193. doi: 10.1016/j.ajog.2014.01.026 . | Open in Read by QxMD
  11. Kaakaji Y, Nghiem HV, Nodell C, Winter TC. Sonography of Obstetric and Gynecologic Emergencies. American Journal of Roentgenology. 2000; 174 (3): p.641-649. doi: 10.2214/ajr.174.3.1740641 . | Open in Read by QxMD

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