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Uterine rupture

Last updated: December 13, 2019

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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 4,000 births, and in most cases, during labor. This condition is caused by gross uterine distention or uterine scarring; patients who have had a C-section 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 C-section. If the uterus is severely damaged and cannot be repaired –or the bleeding does not cease– hysterectomy is necessary.

Incidence: 1/4000 births

References:[1][2]

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.

References:[3][4][5][6]

  • Uterine rupture: connection to the abdomen
  • Uterine dehiscence (closed rupture): perforation covered by the visceral peritoneum

Imminent rupture

  • 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

Uterine rupture

References:[3][4][5][7][8][9]

  • Uterine dehiscence
    • Closed rupture
    • Occurs mostly as a result of a scar rupture in the late months of pregnancy or when contractions begin
    • Most cases of uterine dehiscence are an incidental finding during repeat cesarean delivery.

References:[5][10]

See differential diagnosis of antepartum bleeding.

The differential diagnoses listed here are not exhaustive.

References:[4][5][10]

References:[5][10]

  1. Uterine Rupture. https://www.npeu.ox.ac.uk/ukoss/current-surveillance/ur#r6. Updated: December 9, 2014. Accessed: January 2, 2017.
  2. Al-Zirqi I, Stray-Pedersen B, Forsén L et al.. Uterine rupture: trends over 40 years. BJOG: An International Journal of Obstetrics and Gynaecology. 2016; 123 (5): p.780-7. doi: 10.1111/1471-0528.13394 . | Open in Read by QxMD
  3. Nahum GG. Uterine Rupture in Pregnancy. In: Isaacs C, Uterine Rupture in Pregnancy. New York, NY: WebMD. http://reference.medscape.com/article/275854. Updated: March 25, 2016. Accessed: January 2, 2017.
  4. Augustin G. Acute Abdomen During Pregnancy. Springer ; 2014
  5. Carr PL, Ricciotti HA, Freund KM, Kahan S. In a Page OB/GYN & Women's Health . Blackwell Publishing ; 2003
  6. 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
  7. Callahan TL, Caughey AB. Blueprints Obstetrics and Gynecology. Lippincott Williams&Wilki ; 2013
  8. Iyer PW. Nursing Malpractice. Lawyers & Judges Pub Co ; 2001
  9. Pollak AN, Murphy M, Stathers CL et al.. Critical Care Transport. Jones and Bartlett Publishers ; 2011
  10. Lang CT, Landon MB. Uterine rupture after previous cesarean delivery. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/uterine-rupture-after-previous-cesarean-delivery.Last updated: November 1, 2016. Accessed: January 2, 2017.