The Indian Practitioner

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Uterine Rupture: Fatal Emergencies Continue to Occur Whys and Possibilities of Prevention


Affiliations
1 Obstetrics Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
     

   Subscribe/Renew Journal


Introduction: Uterine rupture is a fatal emergency, which leads to high maternal, perinatal morbidity, mortality continues to occur. Present article is with the objective of update and sharing.

Present status: Uterine rupture could be complete or incomplete (inner layers torn but outer intact, or outer layer with part of myometrium torn but not extending into inner layer). Frequency in the developed countries was decreased because of availability, utilisation of quality care, but recent reports reveal increase, may be due to more interventions/more caesarean births. So there is renewed interest. Rupture could occur spontaneously during pregnancy in a weakened uterus of multiparity or previous caesarean section or other surgery or accident or intrauterine, manipulations. During labour it could be spontaneous, either because of obstruction due to contracted, deformed pelvis, malpresentations, multiple pregnancy, macrosomia, foetal anomalies, oxytocics, PCS, other surgery or perforation or trauma or previous uterine rupture or uterine anomaly. Diagnosis is delayed, unless possibility of rupture is kept in mind, because prior to circulatory collapse, signs, symptoms, may appear bizarre. Classic signs, sudden tearing pain, vaginal bleeding, cessation of contractions, regression of foetus are frequently absent. Non reassuring foetal heart rate may be indicative of imminent rupture. Thorough history/clinical examination are enough for diagnosis. Ultrasound shows abnormal foetal position/haemoperitoneum. Fatal exsanguination may supervene if broad ligament haematoma of incomplete rupture gives way relieving tamponading effect. Hypofibrinogenaemia may lead to complications. Therapy is general, depending on condition of patient, followed by laparotomy repair of rupture with or without tubectomy or hysterectomy depending on age, parity, patient's condition, rupture site, skill of surgeon.

Conclusion: It is essential to try prevention of rupture uterus, a catastrophic event by appropriate timely prenatal, intranatal evidence based care. If it occurs the mission has to be quality survival.


Keywords

Rupture Uterus, Causes, Prevention, Management.
Subscription Login to verify subscription
User
Notifications
Font Size


  • Kadowa I. Ruptured uterus in rural Uganda: prevalence, predisposing factors and outcomes. Singapore Med J. 2010;51(1):35-8

  • Aboyeji AP, Ijaiya MD, Yahaya UR. Ruptured uterus: a study of 100 consecutive cases in Ilorin, Nigeria. J Obstet Gynaecol Res. 2001; 27: 341– 8.

  • Olatunji AO, Sule-Odu AO, Adefuye PO. Ruptured uteri at Sagamu, Nigeria. Niger Postgrad Med J. 2002; 9: 235– 9.

  • Adamu RM, Obed SA. Ruptured uterus: a seven-year review of cases from Accra, Ghana. J Obstet Gynaecol Can. 2003; 25: 225– 300

  • Joseph KS, Liu S, Rouleau J, Kirby RS, Kramer MS, Sauve R, Fraser WD et al. for the Maternal Health Study Group of the Canadian Perinatal Surveillance System. Severe Maternal Morbidity in Canada, 2003 to 2007: Surveillance Using Routine Hospitalization Data and ICD-10CA Codes. J Obstet Gynaecol Can. 2010;32(9):837-846.

  • Augustin G, Majerović M, Luetić T. Uterine perforation as a complication of surgical abortion causing small bowel obstruction: a review. Arch Gynecol Obstet. 2013;288(2):311-23.

  • Al-Zirqi I, Stray-Pedersen B, Forsén L, Vangen S. Uterine rupture after previous caesarean section. BJOG. 2010;117:809– 820.

  • Miller DA, Goodwin TM, Gherman RB, Paul RH. Rupture of the unscarred uterus. Obstetrics Gynaecology. 1997; 89:671673

  • Farmer RM, Kirschbaum T, Potter D et al. Uterine rupture during trail of labour after previous caesarean section. Am J Obstet Gynecol. 1991;165:996-1001.

  • Wen SW, Rusen ID, Walker M, Liston R, Kramee MS, Baskett J et al.Comparison of maternal mortality and morbidity between trial of labor and elective caesarean section among women with previous cesarean delivery. Am J Obstet Gynecol. 2004;19:1263–1269.

  • Chhabra S, Mishrikotkar P. Complete rupture of gravid uterus. Indian Medical Journal. 1990;84;2.

  • Chhabra S. Bhagwat N, Chakravorty A. Reduction in the Occurrence of Uterine Rupture in Central India. J Obstet Gynecol. 2002;22,1;39 - 42

  • Naz S, Baloch R, Shaikh MS, Perveen R, Ahmad S Preipartum Hysterectomy: a Life Saving Procedure. Pak J Surg.2008;24(4); 224-227.

  • Tahir S. Aleem S. Akram S. Indication and maternal outcome of emergency peripartum hysterectomy. Pak J Med Sci. 2003;19(3):182-186

  • Willmott FJ, Scherf C, Ford SM, Lim K. Rupture of uterus in the first trimester during medical termination of pregnancy for exomphalos using mifepristone/misoprostol. International Journal of Obstetrics & Gynaecology.2008;115(12):1575–1577.

  • Jauniaux E, Jurkovic D. Placenta accreta: Pathogenesis of a 20th century iatrogenic uterine disease. Placenta.2012;33:244-251.

  • Goyal V. Uterine rupture in second-trimester misoprostolinduced abortion after caesarean delivery: a systematic review. Obstet Gynecol. 2009;113(5):1117-23.

  • Boyle M et al. Emergencies around Childbirth a handbook for midwives Chapter 8 P92 (2002)

  • Chauhan SP, Magann EF, Wiggs CD, Barrilleaux PS, Martin JN Jr. Pregnancy after classic cesarean delivery. Obstet Gynecol. 2002;100(5):946-50.

  • Rosen MG, Dickinson JC, Westhoff CL. Vaginal birth after cesarean: a meta-analysis of morbidity and mortality. Obstet Gynecol 1991:77(3):465-470

  • Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, Moawad AH et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581-9

  • The American College Of Obstetricians And Gynaecologist, Practice Bulletin #54: Vaginal birth after previous caesarean. Obstet Gyecol. 2003;104(1):20.-12.

  • American College of Obstetricians and Gynecologists. Vaginal birth after previous cesarean delivery. ACOG Practice Bulletin No. 115. ObstetGynecol.2010;116(2): 450– 463

  • Emembolu JO. Vaginal delivery after two or more previous caesarean sections: is trial of labor contraindicated? J Obstet Gynaecol.1998 ;18(1):20-4.

  • Caughey AB, Shipp TD, Repke JT, Zelop CM, Cohen A, Lieberman E. Rate of uterine rupture during a trial of labor in women with one or two prior cesarean deliveries. Am J Obstet Gynecol. 1999;181(4):872–876

  • Grinstead J. Grobman WA. Induction of labor after one prior cesarean: predictors of vaginal delivery. Am J Obstet Gynecol. 2004;103:534-8. (Level II-2)

  • Caesarean section, NICE Clinical Guideline (2004).

  • Intrapartum care; NICE Clinical Guideline (2007).

  • Chhabra S, Qureshi A, Datta N. Perinatal outcome with HELLP/Partial HELLP Complicating hypertensive disorder of pregnancy An Indian Rural Experience. J ObstetGynaecol. 2006;26(6):531-3.

  • Johnson C, Oriol N. The role of epidural anesthesia in trial of labor. RegAnesth. 1990;15:304–8.

  • Kamel J. Can you feel a uterine rupture with an epidural? 2012. VBAC Facts. http://vbacfacts.com/2012/06/22/can-youfeela-uterine-rupture-with-an-epidural/.

  • Dicle O, Kucukler C, Pirnar T, Erata Y, Posaci, C. Magnetic resonance imaging evaluation of incision healing after cesarean sections. Eur. Radiol. 1997;7:31–34.

  • Stamilio DM, DeFranco E, Paré E, Odibo AO, Peipert JF, Allsworth JE et al. Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery. Obstet Gynecol. 2007;110(5):1075-82.

  • GyamfiC, Juhasz G, Gyamfi P, Stone JL. Increased success of trial of labor after previous vaginal birth after cesarean. Obstet Gynecol. 2004;104:715–719.

  • Leung AS, Leung EK, Paul RH. Uterine rupture after previous cesarean delivery: maternal and fetal consequences; Am J Obstet Gynecol. 1993;169(4):945-50.

  • Megafu U.Factors influencing maternal survival in ruptured uterus. Int J Gynaecol Obstet.1985;23(6):475-80.

  • Ghatak D P. Rupture of the uterus: A review of 146 Cases. Trop Jour Gynae.1990;4:41-4.

  • Fitzpatrick KE, Kurinczuk JJ, Brocklehurst P et al.(2012) Uterine Rupture by Intended Mode of Delivery in the UK: A National Case-Control Study PLoS Med. 2012;9(3):e1001184.doi: 10.1371/journal.pmed.1001184.


Abstract Views: 280

PDF Views: 0




  • Uterine Rupture: Fatal Emergencies Continue to Occur Whys and Possibilities of Prevention

Abstract Views: 280  |  PDF Views: 0

Authors

S. Chhabra
Obstetrics Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
P. Borkar
Obstetrics Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India

Abstract


Introduction: Uterine rupture is a fatal emergency, which leads to high maternal, perinatal morbidity, mortality continues to occur. Present article is with the objective of update and sharing.

Present status: Uterine rupture could be complete or incomplete (inner layers torn but outer intact, or outer layer with part of myometrium torn but not extending into inner layer). Frequency in the developed countries was decreased because of availability, utilisation of quality care, but recent reports reveal increase, may be due to more interventions/more caesarean births. So there is renewed interest. Rupture could occur spontaneously during pregnancy in a weakened uterus of multiparity or previous caesarean section or other surgery or accident or intrauterine, manipulations. During labour it could be spontaneous, either because of obstruction due to contracted, deformed pelvis, malpresentations, multiple pregnancy, macrosomia, foetal anomalies, oxytocics, PCS, other surgery or perforation or trauma or previous uterine rupture or uterine anomaly. Diagnosis is delayed, unless possibility of rupture is kept in mind, because prior to circulatory collapse, signs, symptoms, may appear bizarre. Classic signs, sudden tearing pain, vaginal bleeding, cessation of contractions, regression of foetus are frequently absent. Non reassuring foetal heart rate may be indicative of imminent rupture. Thorough history/clinical examination are enough for diagnosis. Ultrasound shows abnormal foetal position/haemoperitoneum. Fatal exsanguination may supervene if broad ligament haematoma of incomplete rupture gives way relieving tamponading effect. Hypofibrinogenaemia may lead to complications. Therapy is general, depending on condition of patient, followed by laparotomy repair of rupture with or without tubectomy or hysterectomy depending on age, parity, patient's condition, rupture site, skill of surgeon.

Conclusion: It is essential to try prevention of rupture uterus, a catastrophic event by appropriate timely prenatal, intranatal evidence based care. If it occurs the mission has to be quality survival.


Keywords


Rupture Uterus, Causes, Prevention, Management.

References