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1. REPTURED UTERUS
DR.ROGERS,A

2. A 39 years old G4P3L3 at GA37week who came with C/C of LAP which was cramping in nature
radiating to the back associated with vaginal bleeding patient had a hx cesarean delivery two
years ago. O/E conscious, afebrile pale and no LL edema with Bp 90/52 mmhg HR 113b/m and
RR18cpm. Abdominal examination had scar and pain on palpation FHR undetectable.
Investigation done FBP Hb 9g/dl abdominal USS no fetal heart beat was seen.
a) what is the dx
b) list risk factors and complications
c) how will you manage the patient

3. Ruptured Uterus:
Definition: A ruptured uterus refers to a tear or opening in
the uterine wall, often during labor, which allows the fetus
and amniotic fluid to spill into the abdominal cavity.

4. Risk Factors:
Previous uterine surgery (e.g., cesarean section, myomectomy)
Uterine trauma or injury
Grand multiparity (having given birth five or more times)
Prolonged labor
Uterine anomalies
Misuse of uterine stimulants (e.g., excessive use of oxytocin)

5. Cont.…
Placental abnormalities
Use of forceps or vacuum extraction during delivery
Maternal age (above 35 years)
Malpresentation of the fetus
Previous uterine rupture

6. Clinical Features:
Sudden, severe abdominal pain
Vaginal bleeding
Fetal distress or absence of fetal heart tones
Hypovolemic shock (pale, sweaty, rapid pulse, low blood pressure)
Signs of peritonitis (abdominal tenderness, guarding, rebound
tenderness)
Loss of uterine contractions and cessation of labor progress
Physical examination to assess for signs of shock, abdominal tenderness,
and fetal distress

7. Complications:
Maternal hemorrhage
Hypovolemic shock
Fetal distress or demise
Maternal infection (due to spillage of amniotic fluid and fetal
tissues into the abdomen)
Organ damage (e.g., bladder or bowel injury)
Long-term fertility issues
Maternal death

8. Appropriate Investigations:
1. Ultrasound to confirm fetal viability and assess for intra-
abdominal fluid
2. Complete blood count (CBC) to assess for anemia or signs of
infection
3. Blood typing and cross-matching for potential transfusions
4. Coagulation profile if hemorrhage is suspected

9. Differential Diagnosis:
I. Placental abruption
II. Uterine atony
III. Appendicitis
IV. Ovarian torsion
V. Ectopic pregnancy
VI. Acute abdomen due to other causes

10. Treatment Plan:
Immediate resuscitation with intravenous fluids and blood products if
needed
Emergency cesarean delivery to deliver the fetus and placenta and
repair the uterine rupture
Surgical repair of any associated injuries (e.g., bladder or bowel)
Administration of antibiotics to prevent infection
Close monitoring of maternal vital signs and fetal status during and after
surgery
Transfer to a higher level of care if necessary

11. Follow-up Plan:
Close monitoring of the mother for signs of infection, hemorrhage,
or other complications
Assessment of uterine healing and future fertility considerations
Emotional support for the mother and family members who may
have experienced a traumatic birth experience
Contraceptive counseling if future pregnancies are deemed high-
risk

12. Any suspicion or confirmation of uterine rupture warrants
immediate referral to an obstetrician or maternal-fetal medicine
specialist.
If the facility does not have the capacity to manage obstetric
emergencies such as uterine rupture, transfer to a tertiary care
center with appropriate resources is necessary.

13. IT'S IMPORTANT TO NOTE THAT RUPTURED UTERUS IS A LIFE -THREATENING
OBSTETRIC EMERGENCY REQUIRING PROMPT RECOGNITION AND INTERVENTIO N
TO OPTIMIZE MATERNAL AND FETAL OUTCOMES. EARLY REFERRAL AND TRAN SFER
TO A FACILITY CAPABLE OF MANAGING SUCH EMERGENCIES ARE CRITICAL.

14. Any question???????