2. Definition
• Disruption in the continuity of the all uterine layers (endometrium,
myometrium and serosa) any time beyond 28 weeks of pregnancy is
called rupture of the uterus.
• Small rupture to the wall of the uterus in early months is called
perforation.
7. PROGNOSIS
• depends upon the manner in which labor is managed prior to the
accident, type of rupture, morbid pathological changes at the site of
the rupture and the effective management.
• Lower segment scar rupture gives a comparatively better prognosis.
But, rupture following obstructed labor either spontaneous or due to
instrumentation gives a maternal death rate of about 20% or more.
• The major causes of death are hemorrhage, shock and sepsis. Late
sequelae include intestinal obstruction and scar rupture in
subsequent pregnancies
8. DIAGNOSIS
During pregnancy
• Scar rupture
• c/o dull abdominal pain over the scar area
• Slight vaginal bleeding
• Varying degrees of tenderness on uterine palpation
• FHS- Irregular or absent
• CTG-variable or late deceleration
• Abdominal pain and collapse
9. Spontaneous rupture in uninjured uterus
• In acute types patient c/o acute abdominal pain with fainting attacks
and may collapse
• Presence of features of hypovolemia ,shock
• Acute tenderness on abdominal examination and palpation of
superficial fetal parts
• Absence of fetal heart rate
10. Rupture following fall ,blow, external version ,use oxytocics
• h/o such an accident
• Acute abdominal pain
• Slight vaginal bleeding
• Rapid pulse
• Tender uterus
• Confirmation by laprotomy
11. DURING LABOUR
• Scar rupture
• Spontaneous obstructive rupture
• Sense of something giving away at the height of uterine contraction
• Constant pain changed to dull aching pain with cessation of uterine contractions
• On examination, features of exhaustion and shock
• On abdominal examination
• Superficial fetal parts
• Absence of FHS
• Absence of uterine contour
12. • Two separate swellings- one contracted uterus and fetal ovoid
• Vaginal examination
• Recession of presenting part
• Varying degrees of bleeding
• Spontaneous non obstructive rupture
• At the height of uterine contractions patients get agonising bursting pain
followed by relief with cessation of contractions
• Diagnostic features-presence of shock, evidences of internal hemorrhage,
tenderness over the uterus,varying amount of vaginal bleeding
13. Rupture following manipulative or instrumental delivery
• Sudden deterioration of patient’s condition with varying amount of
vaginal bleeding
• Shortening of the cord
• Placenta being extruded into the abdominal cavity
14. Management
Prophylaxis
• The at-risk mothers, likely to rupture, should have mandatory hospital delivery. These are-(a) Contracted
pelvis, (b) Previous history of CD, hysterotomy or myomectomy, (e) Uncorrected transverse lie, (d) High
parity.
• General anesthesia should not be used to give undue force in external version.
• Undue delay in the progress of labor in a multipara with previous uneventful delivery should be viewed
with concern and the cause should be sought for.
• Judicious selection of cases with previous history of cesarean sections for vaginal delivery (VBAC).
• Attempted forceps delivery or breech extraction through incompletely dilated cervix should be avoided.
• Destructive vaginal operations should be performed by skilled personnel and exploration of the uterus
should be done as a routine following delivery. Manual removal in morbid adherent placenta-should be
done by a senior person.
