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Uterine rupture
From WikEM
Contents
Background
Prevalence
- No prior c-section = 0.01%
- Prior c-section = 0.2-0.8%
Risk factors
- Prior c-section (major)
- Malpresentation
- Labor dystocia
- Hypertension
- Bicornuate uterus
- Grand multiparity
- Connective tissue disorder
- Placenta percreta
- Prior myomectomy
- Misoprostol use (oxytocin likely safe)
- Typically occurs during labor
Evaluation
- Ultrasound
- Disruption of myometrium
- Free peritoneal fluid (FAST+)
- Anhydramnios/empty uterus
- Herniated amniotic sac
- Fetal anatomy outside of uterus
- Absence of FHR
- Maternal Clinical
- Persistent abdominal pain with peritoneal signs
- Vaginal bleeding
- Maternal shock
- Loss of fetal station
- Palpable uterine defect
Differential Diagnosis
Vaginal Bleeding in Pregnancy (>20wks)
- Placental abruption
- Placenta previa
- Vasa previa
- Uterine rupture
- Preterm labor
- Vaginal trauma
- Placenta accreta
- Intrauterine fetal demise
Postpartum Emergencies
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- Postpartum endometritis
- Postpartum headache
- HELLP syndrome
- Postpartum hemorrhage
- Mastitis
- Peripartum cardiomyopathy
- Preeclampsia
- Retained products of conception
- Uterine rupture
Management
- Fluid resuscitation
- Blood product replacement
- Emergent delivery of fetus
