Rupture of Uterus (Prevention and Management)

An Obstetric Emergency.

A catastrophic event in pregnancy and labor.

Uncommon in the developed countries.

Common in developing countries.

Associated with high maternal mortality and prenatal mortality and mortality.

Incidence of 0.03-0.3;

1:5,700 to 1:20,000 in Ilorin 1:210(2001)-1:298(1997).

Definition:

A disruption of full thickness uterine of wall with expulsion of fetal parts and or placenta tissue into the peritoneal cavity.

Unscarred pregnant uterus:

• Grand multiparity
• Prolonged/obstructed labour
• Injudicious use of uterotonics
• Malpresentations
• Breech extraction
• Instrumental delivery
• Trauma (RTA, obstetrics maneuvers i.e. Internal/External podalic version)
• Placenta percreta
• Diverticulum/sacculation
• Uterine malformations i.e bicornuate uterus or septate uterus
• Overdistention of the uterus

Scarred uterus:

• Previous uterine Surgery including;
• Caesarean delivery
• Myomectomy
• Hysteroscopy Surgery
• Uterine perforation

Symptoms

• Severe abdominal pain of sudden onset
• Epigastric pain, Shoulder pain
• Cessation of uterine contraction
• Bleeding per vaginam
• Hematuria e.g. when the rupture involves the bladder

Signs of blood loss

• Hypotension
• Tachycardia
• Collapse

Abdominal sign

• Tense
• Distended abdomen
• Tenderness
• Palpable fetal parts separate from the uterus, absent fetal cardiac activity
• Signs of intraperitoneal bleeding
• Altered uterine contours
• Fluid thrill

Vagina examination

• Bleeding per vaginam might be seen in the early stages when the uterus is not deeply engaged in the pelvis.

Diagnosis is usually mainly clinical.

Urgent PCV, Group and cross match 2-6/unit of blood

Viral markers

Emergency USS if readily available.

0₂ administration

I/V Fluids

Urgent PCV, group and Xmatch 4 units of blood.

Anesthetist/Theatre

Surgical Rx

Treatment must be individualized for patient; no universal treatment for everyone

• TAH
• Subtotal hysterectomy
• Repair
• Repair + BTL

The surgical treatment chosen would depend on factors such as

• Competency of the healthcare provider
• Presence of infection
• Reproductive wishes of the patient

Hypovolemic shock

Acute renal failure

DIC

Pulmonary Embolism

Paralytic ileus