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4 Uterine Rupture

A 35-year-old female patient, who was pregnant with her fourth child and had one previous cesarean section, presented to the emergency department in labor and was 8 cm dilated. Two hours later, she experienced severe abdominal pain and fetal bradycardia was detected. This raises the differential diagnosis of uterine rupture, which is a life-threatening condition for both mother and baby that involves a complete separation of the uterine musculature. Immediate laparotomy and delivery of the fetus is required for management, with potential options of hysterectomy or uterine repair depending on various factors.

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Aamal Alhami
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58 views14 pages

4 Uterine Rupture

A 35-year-old female patient, who was pregnant with her fourth child and had one previous cesarean section, presented to the emergency department in labor and was 8 cm dilated. Two hours later, she experienced severe abdominal pain and fetal bradycardia was detected. This raises the differential diagnosis of uterine rupture, which is a life-threatening condition for both mother and baby that involves a complete separation of the uterine musculature. Immediate laparotomy and delivery of the fetus is required for management, with potential options of hysterectomy or uterine repair depending on various factors.

Uploaded by

Aamal Alhami
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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UTERINE RUPTURE

DEEMA ALARAMEEN
• A 35 year-old female patient , G4 P3 previous one cesarean section on her 40 weeks of
gestation, came to emergency department in labor. Pelvic examination revealed 8cm dilatation
of the cervix , cephalic presentation , +2 station
2 hours later she became agitated complained of sever abdominal pain . On examination; BP
75/60, vaginal spotting and loss of station.

CTG showed fetal bradycardia .

What are the Differential diagnosis ?


What to do ?
• A 35 year-old female patient , G4 P3 previous one cesarean section on her 40 weeks of
gestation, came to emergency department in labor. Pelvic examination revealed 8cm dilatation
of the cervix , cephalic presentation , +2 station
Two hours later she became agitated, complained of sever abdominal pain .
On examination; BP 75/60 , vaginal spotting and loss of station.
CTG showed decrease amplitude of contraction and fetal bradycardia .
UTERINE RUPTURE

• Complete separation of the uterine


musculature through all of its layers,
ultimately with all or part of the fetus being
extruded from the uterine cavity.

• LIFE THREATENING TO BOTH THE MOTHER


AND THE FETUS.

• With or without previous scared uterus.

• Overall incidence 0.5 %


Previous C/S

Multiparou
IOL
s

Placenta
percreta Risk myomecto
Factors my

Uterine
anomal Overdisten
y -tion
Trauma
CLINICAL PRESENTATION
• UTERINE SCAR DEHISCENCE:
❖ Maternal tachycardia, fetal distress.

• IMPENDING RUPTURE:
❖ Bandl’s ring.
❖ LUS becomes stretched and painful to touch.
❖ Tetanic contractions.
❖ Anxious and restless.
BANDL’S SIGN
CLINICAL PRESENTATION

• HIGHLY VARIABLE
• Typically:
- Sudden onset of intense ab. Pain, and some vaginal bleeding.
- Abnormal fetal heart pattern.
- +/- vaginal bleeding.
- Presenting part may be found to be retracted.
- Cessation of uterine contractions.
• FOLLOWING DELIVERY:

- Signs of shock.
- Contracted uterus with ab. tenderness.
- Vaginal bleeding.
- PPH
HIGH SUSPICION IS REQUIRED FOR
DIAGNOSIS
MANAGEMENT

• CALL FOR HELP!


• RESUSSITATION
• IMMEDIATE LAPAROTOMY and DELIVER OF THE FETUS
• HYSTERECOMY VS UTERINE REPAIR
• UTERINE REPAIR:

◆ Localized rupture
◆ Clean edges, not edematous
◆ No infection
◆ Desire future childbearing
◆ Low transverse
◆ No extension to surrounding area
◆ Good general condition
◆ No evidence of coagulation consequences.
• If the pt undergoes a repair of the uterus, all subsequent pregnancies will be delivered via
cesarean birth at 36 w .
COMPLICATIONS & OUTCOME
• Maternal mortality is less than 1% whereas Fetal mortality is still about 30%.
• Maternal complications :
Hemorrhage and Shock
AFE
DIC
bladder laceration
hysterectomy
Death
• Fetal complication :
Hypoxia , Anoxia
Asphyxia
neurological sequele
Death
THANK YOU

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