Rupture Uterus

Rupture Uterus
Rare event
Incidence 0.3/1000 deliveries
Prompt diagnosis
Prompt treatment
Delayed diagnosis  Increased
maternal mortality
 Action Plan
When to suspect?

 Beware of fetal distress in association

with risk factor for uterine rupture
 Action Plan -- Maintenance of
Airway
Assess
Maintain patency
Oxygen 15 l/mt via tight fitting mask
Attach pulse oximeter
Call anaesthetist
Consider tracheal intubation
 Action Plan -- Maintenance of
Breathing
Assess

Ventilate

Protect airway
 Action Plan -- Maintenance of
Circulation
 Assess pulse and BP
 CPR if necessary
 Put on ECG and automatic BP monitor
 Treat periarrest arrythmias
 Secure IV access using two large bore
cannulae
 Send blood for FBC, cross match 6 units and
clotting screen
 Replace intravascular volume as necessary
 Action Plan
Call senior obstetrician
Obtain consent for laparotomy and
hysterectomy
Baby alive, cervix fully dilated 
consider instrumental delivery
Perform urgent laparotomy under GA
Prophylactic antibiotics
Type of operation is dictated by the size
and site of rupture, the degree of
haemorrhage and patient’s future
fertility wishes
Document in details, incident,
assessment, treatment and
management plan with date, time and
signature
 When to suspect ?
 Suspect  beware of fetal distress in
association with risk factor for uterine
rupture
 Sign
 Commonest prolonged FHR deceleration (70%)
 Pain and bleeding, unreliable (7.6% & 3.4%)
 Cessation of uterine actions with CTG evidence
of fetal distress
 Risk Factors
 Previous CS esp if subjected to oxytocics
 Previous uterine trauma / surgery
 Oxytocic usage in multiparous patients
 Mullerian tract anomalies
 Forceps deliveries esp Kielland’s
 Multipara with previous FTND and significant
larger baby or malposition in present
pregnancy when allowed a prolonged second
stage
 Site of Rupture
 Dehiscence of lower uterine segment in
cases of previous LSCS
 Rupture may extend anteriorly towards back
of bladder, laterally towards uterine arteries
or into broad ligament plexus of veins  PPH
 Posterior rupture is associated usually with
uterine malformations. Also seen with post
CS, following obstructed labor and rotational
forceps deliveries
 Surgical Procedure
Sustained haemorrhage indication for
hysterectomy
Subtotal simpler and quicker besides less
risk for damage to bladder and ureter
• RUPTURE UTERUS
 Bandl’s Ring
Also known as Retraction Ring

Seen in Obstructed labor

 Pathological Retraction Ring
Gradual increase in intensity, duration and
frequency of uterine contractions
Phase of relaxation decreases
Ultimately tonic contraction sets in
Retraction continues
Lower segment thinned and stretched
Formation of circular groove between active
upper and distended lower segment
Pronounced retraction decreased flow at
placental site  fetal distress
 Progress of labor
Labor ceases in response to obstruction
because of uterine exhaustion
In multigravida retraction continues with
progressive thinning and dilatation of lower
segment and progressive elevation of
Bandl’s ring closer to umbilicus  rupture
of lower segment
 Clinical Features
Pain discomfort because of prolonged labor
Maternal exhaustion
Keto acidosis
Upper segment hard and tender
Lower segment distended and tender
Ring appreciated running obliquely
between umbilicus and symphysis pubis 
rises with time
Taut and tender round ligaments
Absent FHS usual
Dry vagina, offensive discharge
Cervix fully dilated
Cause of obstruction apparent
 Management
Condition preventable
Supportive treatment-
IV fluids
Treatment of keto acidosis
Sedation
Antibiotics
Definitive – Relieve obstruction by safe
procedure after excluding uterine rupture