Rupture Uterus

Presentation By

Vincentia Sarfo-Brobbey

2/11/2021 1
 Definition
§ Rupture uterus is the total disruption of the
wall of the pregnant uterus with or without
the expulsion of its contents (either the baby
or the placenta).

§ Ruptured uterus is one of the major life

threatening complications in obstetrics. It
occurs during labour and delivery and to a
lesser extent during pregnancy.

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 Types of Ruptured Uterus
Complete Rupture
§ It involves a tear in the wall of the uterus
with or without expulsion of the foetus.The
peritoneum overlying the uterus is also
disrupted.
Incomplete Rupture
§ It involves tearing of the myometrium but
not the pelvic perimetrium

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 Types of Ruptured Uterus
Dehiscence
§ Dehiscence of an existing uterine scar may
also occur.
§ This involves rupture of the uterine wall but
the foetal membranes remain intact.
§ The foetus is retained within the uterus and
not expelled into the peritoneal cavity.

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 Types of Ruptured Uterus
§ Ruptured uterus can also be described as:
I. Traumatic (Iatrogenic)
When preceded by some form of intervention e.g.
Uterine manipulations, misuse of oxytocic drugs
and prostaglandins and use of instruments
II. Spontaneous
When it occurs without any manipulations.

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 Sites of Uterine Rupture
Unscarred Uterus
§ Longitudinal tears appear to be more
common in ruptures in the unscarred uterus
Scarred Uterus
§ In these cases, the rupture is usually
through the scar. The risk of scar rupture in
a subsequent pregnancy following a
longitudinal incision in the upper uterine
segment is estimated to be 4–12%.

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 Sites of Uterine Rupture
§ In a pregnancy following a previous lower
segment caesarean section, the risk of
rupture is 1.22–1.5%.

§ Although the rupture usually follows the

line of the scar there are cases of
transverse rupture into the posterior lower
uterine segment and vertical lower
segment ruptures

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 Causes of Ruptured Uterus
Obstructed Labour
§ The obstruction may be due to foeto-pelvic
disproportion, malpresentation and
malposition and from a contracted pelvis, or a
big baby.
Uterine Hyperstimulation
§ Uterine hyperstimulation with oxytocics
particularly in the presence of disproportion,
mal position or high parity.
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 Causes of Rupture Uterus
§ Previously scarred uterus as found in
caesarean section, hysterotomy, repaired
uterine rupture, extensive myomectomy etc
§ Intrauterine manipulation during labour and
delivery such as
I. Internal podalic version
II. Manual removal of retained placenta
§ Neglected labour, where there is previous
history of caesarean section
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 Clinical Manifestations
A. Ruptured caesarean section scar
§ This is difficult to detect as the rupture is
silent
I. There is lower abdominal pain in between
contractions
II. Slight vaginal bleeding
III. Shock if there is greater degree of bleeding or if
the tear becomes complete

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 Clinical Manifestations
B. Rupture During Obstructed Labour (Intrapartum
rupture)
§ There is a history of long difficult labour, bandl’s
ring and obstructed labour
§ Signs of severe shock such as cold moist skin, low
blood pressure, feeble and rapid pulse rate(fast,
weak pulse).
§ The woman complains severe abdominal pains
with something giving way then;
§ Sudden collapse

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 Clinical Manifestations
B. Rupture During Obstructed Labour
(Intrapartum rupture)
§ Heart sounds may be lost , or there may be
changes such as variable decelerations.
§ There may be evidence of fresh vaginal
bleeding
§ The uterine contractions may stop
§ The contour of abdomen changes.

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 Clinical Manifestations
B. Rupture During Obstructed Labour
(Intrapartum rupture)
§ The foetal parts can be palpated easily
through the abdominal wall.
§ Note: The degree and speed of the
mother’s collapse and shock depend on the
extent of the rupture and the blood loss.

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 Management
Community/Health Centre
The midwife should:
§ Put the client in the lateral position and raise legs on
pillows.
§ Provide warmth
§ Take blood for grouping and cross-matching
§ Give IV fluid
§ Check temperature, pulse, respiration and blood pressure.
§ Insert a catheter
§ Organise blood donors
§ Give antibiotics
§ REFER
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 Management
Hospital
§ The midwife should call the doctor
§ Put the client in the lateral position and raise
legs on pillows
§ Provide warmth
§ Blood is taken for grouping and cross-
matching
§ IV fluid is given

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 Management
HOSPITAL
§ The midwife should check the temperature, pulse
respiration and blood pressure ¼ hourly.
§ A catheter is inserted.
§ The doctor will prescribe antibiotics.
§ The midwife should give the drugs accordingly, and
§ Prepare the client psychologically and physically for
surgery.
§ The doctor will perform hysterectomy or repair of
the uterus (depending on the severity).

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 Principle for Treatment
§ Intensive resuscitation

§ Emergency laparatomy

§ Broad Spectrum antibiotics

§ Adequate postoperative care

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 Complications
Maternal
Before Surgery
• Hypovolaemic Shock
• Infection
• Death
After Surgery
• Pyrexia
• Intestinal obstruction
• Anaemia
• Adhesions
• Genital tract and wound sepsis
• Urogenital fistula(vesicovaginal fistula)
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 Complications
Foetal
§ Hypoxia
§ Anaemia
Note: Ruptured uterus may result in the death
of both the mother and the foetus.

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 Signs of Eminent Uterine Rupture
§ All the signs of obstructed labour are
present such as
§ Rising pulse rate (maternal)
§ Tonic contractions (pain)
§ Bandl’s ring may be seen abdominally
§ Tenderness over the lower uterine segment
§ Foetal distress

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