1. RUPTURE OF THE
UTERUS
FAHAD ZAKWAN

3. INTRODUCTION
 Uterine rupture is a grave obstetric complication.
 Associated with high
 Maternal mortality
 Perinatal mortality
 It may occur
 Labour
 Delivery
 Pregnancy – lesser extent
 Every second of time is vital for survival

4. Incidence of uterus rupture
• 0.05% for all pregnancies
• 0.8% after previous lower segment caesarean
section(LSCS)
• >5% after classical caesarean section
• Scar dehiscence has an incidence of 0.6% in
pregnancies with previous C/S and has a more
favourable outcome for both mother and fetus than
does uterine rupture.

5. Definition
•Separation of the muscular wall of the
uterus
•Usually occurs during labor
•Occasionally happen during the later
weeks of pregnancy

6.  Uterine rupture
 Total disruption of the wall of the pregnant uterus with or
without extrusion of its contents
 Uterine scar dehiscence
 Herniation of intact amniotic membrane into an existing
uterine scar
 Uterine scar rupture
 Separation of the scar along its entire length often with
involvement of the amniotic membranes

7. •Uterine dehiscence involves myometrial
separation at a site of uterine scar from
previous surgery, and the uterine serosa
remains intact.
•Uterine rupture, on the other hand, involves
the entire thickness of the uterine wall,
resulting in communication between the uterus
and peritoneal cavities.

8. •Uterine rupture: separation of an old uterine
incision with rupture of the fetal membranes so
that the uterine cavity and the peritoneal cavity
communicate directly.
•Dehiscence of a scar does not involve rupture of
the fetal membranes.
•Rupture is more acute while dehiscence is more
gradual.

9. CAUSES
During pregnancy
•weak scar after previous operations on the uterus
•History of cesarean section (VBAC - vaginal birth after c-
section)
•myomectomy
•excision of a uterine septum
•previous perforation of uterus(D&C, hysteroscopy,
forceps delivery

12. During labor:
•uterine hyper-stimulation(oxytocin with pitocin induction
or augmentation of labor)
•obstructed labor(macrosomia, feopelvic dispropotion)
•intrauterine manipulation(internal version, manual
removal of an adherent placenta)
•forcible dilatation(cervical tear)
•a weak scar(C-section or other operations)

15. TYPES
•Incomplete rupture
•complete rupture
depending on whether the
peritoneal coat is torn through or
not

16. Traditional classification
Complete
▪The visceral peritoneum overlying the
uterus is disrupted
Incomplete
▪Overlying peritoneum is intact
Not clinical relevant

17. Etiological classification
Spontaneous rupture
Scar rupture
Traumatic rupture

19. Spontaneous rupture
• Feto-pelvic disproportion
• Congenital uterine anomalies
• Soft tissue obstruction
Scar rupture
• Previous uterine surgery
• Previous uterine perforation
PREDISPOSING FACTORS

20. Traumatic/ iatrogenic rupture
Surgical intervention
Internal version
Forceps delivery
Manual removal of placenta
Destructive operations
Medical intervention
Uterine stimulation

21. Symptoms and signs
• Abdominal pain and tenderness
• Shock
• Vaginal bleeding
• Undetectable fetal heart beat
• Palpable fetal body parts
• Cessation of contractions
• Signs of intraperitoneal bleeding
• The most common sign is the sudden appearance of
fetal distress during labor

25. •The signs and symptoms of uterine
rupture in patients with a previous
scarred uterus differ from patients
without a uterine scar.
•The most common sign in woman with
uterine scar is lower abdominal
•In women without a scar, shock is the
common sign, followed by uterine
abdominal pain, and easily palpable fetal

26. •Ultrasonography is probably the safest
and most useful imaging technique during
pregnancy.
•sonographic findings associated with
includes:
• Extra peritoneal hematoma
• intrauterine blood
• free peritoneal blood
• empty uterus
• gestational sac above the uterus
• large uterus mass with gas bubbles
DIAGNOSIS

28. TREATMENT
•Principles for the treatment of uterine
rupture includes:
•Intensive resuscitation
•Emergency laparotomy
•Broad spectrum antibiotics
•Adequate post operative care

29. Intensive resuscitation
 Correct hypovolaemia from….
 Haemorrhage
 Sepsis
 Dehydration
 Intravenous broad spectrum antibiotics
 Cephalosporin + Metronidazole combination
 Monitor to ensure adequate fluid and blood replacement
 Blood volume expansion may worsen the bleeding from damaged vessel and
so the laparotomy should not be delay, once patient condition has improved

30. Surgical options
 Hysterectomy
 Treatment of choice except any other compelling reasons
to preserve the uterus
 Total
 Sub-total
 Rupture repair
 Occasionally one may be forced to repair
 Repair with sterilization
 Not an attractive option
 May be useful especially in unskilled hands

31. Outcome
• Death from uterine rupture is not uncommon.
• Mortality appears to be higher in women who have
an unscarred uterus and when the rupture occurs
outside the hospital.
• Overall mortality: 15.9%
• Perinatal morbidity rate associated with uterine
rupture ranges from 8-56%

32. Preventive measures
Antenatal care
High risk cases
Oxytocics
Previous caesarean section
Augmentation of labour

33. NOTE!!!
•During trial of scar watch out for…….
•Fetal heart abnormalities
•Maternal tachycardia
•Vague abdominal pain in between contractions
•Suprapubic tenderness
•Vaginal bleeding
•Bladder tenesmus

34. DIAGNOSTIC CRITERIA FOR UTRINE
RUPTURE
Painful late trimester bleeding
Loss of FHT
Inability to identify UCs

37. Thank you for your
attention