Summary about Disease
Uterine rupture is a tear in the wall of the uterus. It's a serious obstetrical emergency, most often occurring during labor in women who have had a previous Cesarean delivery or other uterine surgery. Uterine rupture can lead to severe hemorrhage, fetal distress, and maternal and fetal mortality. Prompt diagnosis and treatment, typically involving emergency Cesarean delivery and uterine repair or hysterectomy, are crucial.
Symptoms
Sudden abdominal pain, which may be described as a ripping or tearing sensation.
Vaginal bleeding.
Signs of shock (e.g., rapid heart rate, low blood pressure, sweating, anxiety).
Cessation of uterine contractions.
Fetal distress (e.g., abnormal fetal heart rate patterns).
Recession of the fetal presenting part (the baby seems to move back up in the birth canal).
Palpation of fetal parts outside the uterus through the abdominal wall (in severe cases).
Causes
Previous Cesarean delivery: This is the most common risk factor, especially if a trial of labor after Cesarean (TOLAC) is attempted.
Other uterine surgeries: Myomectomy (removal of fibroids), uterine perforation during dilation and curettage (D&C).
Uterine overstimulation: Excessive use of oxytocin or prostaglandins to induce or augment labor.
Obstructed labor: When the baby cannot pass through the birth canal due to its size, position, or other factors.
Uterine abnormalities: Congenital uterine malformations.
Trauma: Blunt abdominal trauma (rare).
Grand Multiparity: Having many previous pregnancies.
Medicine Used
There are no medicines that can treat a uterine rupture directly.
Emergency treatment: Focuses on stabilizing the mother with intravenous fluids and blood transfusions to address blood loss and shock.
Antibiotics: Administered to prevent infection after surgery (Cesarean delivery and uterine repair or hysterectomy).
Oxytocic drugs (e.g., Oxytocin): May be used after the uterus is repaired to help it contract and prevent further bleeding. *Oxytocin is a cause of rupture, so it would not be used prior to surgical intervention.*
Is Communicable
No, uterine rupture is not a communicable disease. It is a mechanical complication related to pregnancy and childbirth.
Precautions
Careful selection of candidates for TOLAC: Thoroughly evaluating the risks and benefits of vaginal birth after Cesarean.
Monitoring during labor: Close monitoring of uterine contractions and fetal heart rate during labor, especially in women with previous uterine surgeries.
Appropriate use of labor-inducing agents: Avoiding excessive use of oxytocin or prostaglandins.
Prompt recognition and management of obstructed labor: Addressing situations where the baby cannot pass through the birth canal in a timely manner.
Avoiding fundal pressure: In most situations, fundal pressure should be avoided during delivery.
How long does an outbreak last?
Uterine rupture is not an infectious disease and does not involve "outbreaks." It is an acute event that occurs during labor or, rarely, during pregnancy. It requires immediate surgical intervention.
How is it diagnosed?
Clinical suspicion: Based on the patient's symptoms and risk factors.
Abdominal examination: Tenderness, guarding, and palpation of fetal parts outside the uterus.
Fetal heart rate monitoring: Detecting fetal distress patterns.
Internal Examination: May detect vaginal bleeding and/or recession of the fetal presenting part.
Surgical exploration: Confirmation of the diagnosis is typically made during surgery (Cesarean delivery or laparotomy).
Timeline of Symptoms
Symptoms typically develop suddenly and rapidly during labor.
Initial: Sharp abdominal pain, often described as a tearing sensation.
Minutes to Hours: Vaginal bleeding, signs of shock (rapid heart rate, low blood pressure), cessation of uterine contractions, fetal distress.
Progression (if untreated): Worsening hemorrhage, maternal collapse, fetal death.
Important Considerations
Uterine rupture is a life-threatening emergency for both the mother and the baby.
Prompt diagnosis and treatment are essential for improving outcomes.
Women with a history of Cesarean delivery or other uterine surgeries should discuss the risks and benefits of TOLAC with their healthcare provider.
A history of uterine rupture often dictates the need for future deliveries via Cesarean section.
Documentation of maternal and fetal status during labor and delivery is crucial for legal reasons.