Uterine rupture

Overview
Uterine rupture is a potentially catastrophic event during childbirth by which the integrity of the myometrial wall is breached. In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament. A uterine rupture is a life-threatening event for mother and baby.

Etiology
A uterine rupture typically occurs during early labor, but may already develop during late pregnancy. A uterine scar from a previous cesarean section is the most common risk factor. Other forms of uterine surgery that result in full-thickness incisions (such as a myomectomy), dysfunctional labor, labor augmentation by oxytocin or prostaglandins, and high parity may also set the stage for uterine rupture. In 2006, an extremely rare case of uterine rupture in a first pregnancy with no risk factors was reported.

Clinical presentation
Symptoms of a rupture may be initially quite subtle. An old cesarean scar may undergo dehiscence, but with further labor, the paturient may experience abdominal pain and vaginal bleeding. Often a deterioration of the fetal heart rate is a leading sign. Intraabdominal bleeding, of course, can lead to hypovolemic shock and death.

Treatment
Emergency exploratory laparotomy with cesarean delivery accompanied by fluid and blood transfusion are indicated for the management of uterine rupture. Depending on the nature of the rupture and the condition of the patient the uterus may be either repaired or needs to be removed (cesarean hysterectomy).