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2.1
Uterine Rupture
Rupture Uterine

Presentation

We present a case of uterine rupture presenting as significant urinary retention that occurred following a second trimester abortion induced with mifepristone and misoprostol. Uterine rupture was discovered unexpectedly on diagnostic laparoscopy. [ncbi.nlm.nih.gov]

(assisted) (buttocks) (complete) (frank) (spontaneous) 652.2 brow presentation 652.4 cephalopelvic disproportion (normally formed fetus) 653.4 cerebral hemorrhage 674.0 cervical dystocia 661.2 chin presentation 652.4 cicatrix coagulation defect 649.3 [icd9data.com]

Respiratoric

  • Tachypnea

    Chest pain, pain between the scapulae, or pain on inspiration—Pain occurs because of the irritation of blood below the woman's diaphragm Hypovolemic shock caused by haemorrhage— Falling blood pressure, tachycardia, tachypnea, pallor, cool and clammy skin [en.wikipedia.org]

Gastrointestinal

  • Acute Abdomen

    In addition, we recommend laparoscopy for the investigation of acute abdomen with unclear diagnosis in the first trimester of pregnancy. [ncbi.nlm.nih.gov]

  • Abdominal Distension

    A 28-year-old woman at 36 + 6 weeks of gestation presented with mild uterine contractions and developed a sudden abdominal distension. An emergency laparotomy was performed, and the posterior wall of the uterus had ruptured. A baby boy was born. [ncbi.nlm.nih.gov]

    As in [Table 2], abdominal pain was the most common symptom identified and was present in all the 67 cases reviewed (100%). Abdominal tenderness and abdominal distension were the most common general signs seen in 65 (97.01%) of the cases. [jcsjournal.org]

Urogenital

  • Vaginal Bleeding

    Placenta praevia – typically causes a painless vaginal bleeding. Vasa praevia – characterised by a triad of ruptured membranes, painless vaginal bleeding, and fetal bradycardia. [teachmeobgyn.com]

    bleeding Hemodynamic instability (as a result of abdominal bleeding) Loss of fetal station Palpable fetal parts through the rupture References: [5] [7] [8] [4] [9] [3] Subtypes and variants Differential diagnoses See → Differential diagnosis of vaginal [amboss.com]

    Bleeding Vaginal bleeding is a classic finding of UR.. [medicaljoyworks.com]

    Uterine rupture classically presents with severe abdominal pain, loss of fetal station, vaginal bleeding, and shock. [ncbi.nlm.nih.gov]

  • Uterine Hemorrhage

    Prompt maternal supportive and resuscitative measures should be undertaken to avoid catastrophic consequences like life-threatening uterine hemorrhage and maternal shock. Once the rupture uterus is diagnosed, prompt management is the essence. [ijcm.org.in]

Workup

Initial workup revealed placenta accreta and possible percreta (Figure 1 ) [4]. The patient was placed on IM corticosteroids in anticipation of preterm delivery. As soon as the patient was stable, she was discharged home. [cureus.com]

Treatment

Surgical treatment could be the preferred approach for this situation. [ncbi.nlm.nih.gov]

[…] or makes a mistake during treatment. [rossfellercasey.com]

Prognosis

KEYWORDS: Guinea; fetal prognosis; maternal prognosis; maternity Donka; uterine rupture [Indexed for MEDLINE] Free full text [ncbi.nlm.nih.gov]

Treatment and prognosis Uterine rupture is most often an obstetric emergency (especially if associated with pregnancy). [radiopaedia.org]

Prognosis [ 4 ] 6.2% of uterine ruptures are associated with perinatal death. 14-33% of women with uterine rupture require an emergency hysterectomy. [patient.info]

Etiology

Aims and objective: To investigate the incidence, etiology, diagnosis, treatment and outcome of uterine rupture. [jdrntruhs.org]

Obstetricians and gynecologists, family physicians After completing this CME activity, physicians should be better able to compare the etiology and presentation of uterine rupture in resource-poor countries as contrasted with the presentation of this [doi.org]

Etiology 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. [amboss.com]

Etiology of Uterine Rupture Relative imbalance in uterine rupture Uterine ruptures are caused by an imbalance between the strain on the uterine wall and the stability of the uterus. [lecturio.com]

Rupture uterus: changing trends in etiology and management. J Postgrad Med. 1991 Jul;37(3):136-9. 9. Aboyeji AP, Ijaiya MD, Yahaya UR. Ruptured uterus: a study of 100 consecutive cases in Ilorin, Nigeria. [journals.ke-i.org]

Epidemiology

Epidemiology Incidence : 1/4000 births References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. Etiology Uterine rupture is primarily caused by uterine distention. [amboss.com]

Abstract A descriptive study was conducted to investigate the epidemiology and the outcome of uterine rupture at Hajjah Hospital, Yemen, during September 2014-August 2016. [ncbi.nlm.nih.gov]

Kathryn Fitzpatrick and colleagues from the National Perinatal Epidemiology Unit based at the University of Oxford in the UK found that from April 2009 to April 2010, 159 women experienced uterine rupture in the UK, of whom 139 had previously delivered [sciencedaily.com]

Epidemiology of Uterine Rupture Even nowadays, uterine ruptures are very frequent. This severe complication occurs in 1 of 1.500 deliveries. [lecturio.com]

Pathophysiology

Based on the pathophysiology of complete uterine wall separation, changes in uterine activity are expected. The primary objective is to identify tocogram characteristics associated with uterine rupture during trial of labor after cesarean section. [ncbi.nlm.nih.gov]

The pathophysiology of morbidly adherent placenta is characterized by abnormal adherence and invasion of the placenta to the superficial and deep layers of the uterine wall [1]. [cureus.com]

This is expected because uterine rupture is a traumatic event and haemorrhage is part of its pathophysiology. [njcponline.com]

A pathophysiological explanation of this may be the degree of myometrial fragility which is acquired with successive pregnancies [ 15 ]. In our study, it was observed that parity and maternal age were indeed risk factors. [omicsonline.org]

Prevention

How Can Uterine Rupture Be Prevented? Uterine rupture can be significantly harmful for both mother and baby – even resulting in death. So, any preventative measures that can be taken, should be. [rossfellercasey.com]

Once again, preventing the scar helps to prevent the rupture. [midwiferytoday.com]

Can uterine rupture be prevented? The only way to prevent uterine rupture is to have a cesarean delivery. It can’t be fully prevented during vaginal birth. A uterine rupture shouldn’t stop you from choosing vaginal birth. [healthline.com]

Prevention of poor outcomes depends on thorough anticipation and preparation. The physicians and the delivery institution should be prepared to provide emergency surgical and neonatal care in the event of uterine rupture. [ncbi.nlm.nih.gov]

You may also be given antibiotics to prevent infection. [whattoexpect.com]

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