This presentation gives the detailed information about uterine rupture - definition, epidemiology, classification, signs and symptoms, prevention and management.

1. UTERINE RUPTURE
Sandeep Das
4th year MBBS
Gauhati Medical College and Hospital
Guwahati, Assam.

2. DEFINITION
• Uterine rupture
It is defined as “dissolution in the continuity of
uterine wall any time after 28 weeks of gestation,
with or without expulsion of the fetus.”
• Uterine scar dehiscence
It is defined as “separation of walls of the uterus
along the line of the previous scar.”

3. INCIDENCE
• 0.07/1000 births in developed countries
• 0.62/1000 births in India

4. TRADITIONAL CLASSIFICATION
1. Complete rupture
 All the layers of the uterus, including the
peritoneum, are torn.
 Uterine contents escape into the uterine
cavity.
 Usually results in fetal death.
2. Incomplete Rupture
 Visceral peritoneum is intact.
 Usually the fetus lies in the uterine cavity

5. TRADITIONAL CLASSIFICATION

6. ANATOMICAL CLASSIFICATION
• Lower segment rupture
• Rupture of corpus/fundus (upper segment) of uterus

7. ETIOLOGICAL CLASSIFICATION
1. Spontaneous rupture
2. Scar rupture
3. Iatrogenic (Traumatic) rupture

8. ETIOLOGICAL CLASSIFICATION (CAUSES)
During pregnancy During labor
Spontaneous
Rupture
1. Past history of dilatation and
curettage operation/manual
removal of placenta
2. Grand multiparity
3. Couvelaire uterus
4. Congenital malformations of
the uterus
5. Congenital fetal abnormalities
6. Morbidly adherent placenta
7. Collagen disorders
1. Obstructed labor
2. Multiparity
3. Oxytocics and
prostaglandins

9. ETIOLOGICAL CLASSIFICATION (CAUSES)
During pregnancy During labor
Scar rupture 1. Classical caesarean
(hysterotomy) scar
1. Classical caesarean
(hysterotomy) scar
Iatrogenic rupture 1. Injudicious and
unmonitored use of
oxytocics on pregnant
uterus
2. Injudicious use of
prostaglandins on a
pregnant uterus
3. Difficult and forced
external cephalic
version, especially if
performed under
general anaesthesia
4. Abdominal blunt
trauma
1. Internal podalic
version and breech
extraction especially in
cases of obstructed
labor
2. Destructive surgeries
on fetus
3. Manual removal of
placenta
4. Difficult or rotational
forceps delivery in
obstructed labor
5. Injudicious and
unmonitored oxytocin
infusion for
acceleration of labor

10. PATHOGENESIS

12. DIAGNOSTIC TRIAD FOR UTERINE
RUPTURE
1. Painful third trimester bleeding with
unstable vitals
2. Loss of fetal heart sounds
3. Hot, dry vagina on vaginal
examination

13. DIFFERENTIAL DIAGNOSIS
1. Abruptio placentae
2. Amniotic fluid embolism
3. Other causes of acute abdomen

14. PREVENTION
1. Early diagnosis and management of cephalo-
pelvic disproportion (CPD), malpresentations and
other factors leading to obstructed labor.
2. Proper selection of cases for vaginal birth after
caesarean deliveries (VBAC)
3. Careful selection of cases and careful watch
during oxytocin infusion either for induction or
augmentation of labor and to avoid their non-
judicious use, especially in multiparas
4. Avoid all uterine manipulations if the liquor has
drained away.

15. PREVENTION(CONTD.)
5. Instrumental delivery should be performed only
after all the pre-requisites are fulfilled and on no
account should forceps be applied prior to
complete cervical dilatation.
6. In cases of obstructed labor or threatened rupture,
immediate caesarean delivery should be
performed and all intrauterine manipulations
avoided.
7. Hospital delivery for high-risk cases.
8. Forced and difficult external cephalic version
especially under general anaesthesia should be
avoided.

16. PREVENTION(CONTD.)
9. Undue delay in the progress of labor in a
multipara with previous uneventful delivery should
be taken seriously and couse should be looked
into.
10. Manual removal of a morbidly adherent placenta
should be performed gently and carefully by an
experienced obstetrician.

17. TREATMENT
• Resuscitation with adequate hydration,
hemaccel and blood transfusion.
• Laparotomy as a definitive treatment.
The treatment modalities are-
• Hysterectomy
• Repair.