Aug 29, 2019 surgery may be used if medical management fails or in case of cervical lacerations or tear or uterine rupture. Spontaneous uterine rupture in the second trimester of pregnancy is a very rare event1. It may be due to injuries, multiple pregnancies, large fetus, previous scarring, or obstruction. Second trimester spontaneous uterine rupture in a woman with. Non identification dune dystocie au cours du travail avec des contractions. Uterine rupture study 0309 data collection form case please report any woman delivering between 1st april 2009 to 31st march 2010.
The p value was considered significant when p uterine rupture, seven died, giving a lethality rate of uterine rupture of 9. Causes include trauma, labor with an unusually big baby, multiple gestation, and vaginal delivery after a prior csection in which the old csection scar ruptures. Usually, it is either associated with cases of trophoblastic tumor, or pathological invasion of the placenta through uterine wall, for example, placenta increta or percreta 2. Uterine rupture symptoms and signs of a rupture bellybelly. Pdf uterine rupture in douala general hospital, cameroon. To our best knowledge no cases of postpartum uterine rupture. Thirtysix uterine ruptures were registered of which 11 were complete. Uterine rupture in pregnancy is a rare occurrence, but when it happens it can be lifethreatening for both mom and baby.
Uterine rupture, on the other hand, involves the entire thickness of the uterine wall, resulting in communication between the uterus and peritoneal cavities. Uterine rupture is a rare, but serious childbirth complication that can occur during vaginal birth. There is strong association between uterine rupture and previous caesarean section. Any woman in the uk identified as having a uterine rupture using the following definition. Uterine rupture occurs extremely rarely according to one study from the netherlands, the incidence is between 0. Violent traumatic rupture sudden sharp abdominal pain during or between contractions.
A complete separation of the wall of the pregnant uterus, with or without expulsion. Rupture uterine gynecologie et obstetrique edition. Twentyone ruptures 58% were diagnosed during a trial of labour. Whilst the occurrence of uterine rupture is low, it is one of the most lifethreatening obstetric emergencies, with a high rate of both foetal and maternal mortality. Intrauterine anomalies could be the primum movens of this dangerous condition and underestimated in the literature. Uterine rupture occurs most often along healed scar lines in women who have had prior cesarean deliveries.
As uterine scar rupture is itself a rare event, occurring in less than 1% of vbac labours, the overall risk of losing a baby due to uterine rupture is extremely low. Uterine rupture is a serious complication both for mother mortality uterine rupture ur in early pregnancy in nulliparous women is a rare and unpredictable occurrence with high maternal morbidity and fatal fetal outcomes. The risk of uterine rupture among women with a prior cesarean delivery undergoing secondtrimester abortion using misoprostol is less than 0. Uterine rupture definition of uterine rupture by medical. Sep 01, 2002 true uterine rupture is typically distinguished from asymptomatic scar separation dehiscence by the need for emergency surgery, although some reports combine these separate processes and confuse. There are signs that postpartum hemorrhage, stillbirth and the risk of uterine rupture increase in subsequent births among patients who underwent planned css in their previous births when compared to those who underwent emergency cs. The patient was managed conservatively and carried a subsequent pregnancy six months after the intervention. You are more likely to experience a cord prolapse or placental abruption during a vbac labour than uterine rupture. Silent spontaneous rupture of the uterus before term, with extrusion of an intact amniotic sac and delivery of a healthy neonate, with no maternal or neonatal morbidity or mortality is very rare. Uterine rupture is a really uncommon and unpredictable event, an emergency condition, which usually takes place in the course of labor, which has a devastating effect on both the mother and the baby.
May 12, 2015 uterine rupture, on the other hand, involves the entire thickness of the uterine wall, resulting in communication between the uterus and peritoneal cavities. Uterine rupture is spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity. Surgery may be used if medical management fails or in case of cervical lacerations or tear or uterine rupture. Diagnosis and management of a postpartum uterine rupture. Symptoms and signs of uterine rupture include fetal bradycardia, variable decelerations, evidence of hypovolemia, loss of fetal station detected during cervical examination, and severe or constant abdominal pain. Compared to literature data, our frequency is lower than those reported by other studies in africa. Maternal and neonatal outcomes after uterine rupture in labor.
Uterine rupture in first or second trimester of pregnancy. Jun 10, 2018 as uterine scar rupture is itself a rare event, occurring in less than 1% of vbac labours, the overall risk of losing a baby due to uterine rupture is extremely low. Incidence of uterine rupture in maternities with uterine scar over four decades 19672008 in norway. Rupture occurred on an unscared uterus after administration of significant accumulated doses of oral misoprostol 1400g. Second trimester spontaneous uterine rupture in a woman with uterine anomaly. Release the incidence, the risk factors and maternal. Abdominal tenderness uterine contractions may be absent, or may continue but be diminished in intensity and cord bleeding vaginally, abdominally, or both fetus easily palpated in the abdominal with shoulder pain tenses, acute abdominal with shoulder pain signs of shock chest pain from. Silent spontaneous uterine rupture at 36 weeks of gestation. Histological examination revealed the absence of decidua in the uterine fundus and thinning of the myometrium.
A multiparous woman underwent prostaglandin induction of labour for. A uterine rupture is a tear that happens at the wall of the uterus, most often in the region where a past csection incision has been made. Abdominal tenderness uterine contractions may be absent, or may continue but be diminished in intensity and cord bleeding vaginally, abdominally, or both fetus easily palpated in the abdominal with shoulder pain tenses, acute abdominal with shoulder pain signs of shock chest pain. It causes a mothers uterus to tear so her baby slips into her abdomen. Uterine rupture and subsequent pregnancy outcomehow safe is it. Uterine rupture in women attempting a vaginal birth following prior cesarean birth. Following a previous caesarean section the incidence increases to 227410,000 deliveries if vaginal birth after caesarean vbac is attempted. It can occur during late pregnancy or active labor. Spontaneous uterine rupture of an unscarred uterus before labour.
Uterine rupture definition msh a complete separation or tear in the wall of the uterus with or without expulsion of the fetus. The risk of uterine rupture exists when there is an associated uterine andor placenta factor. Multiparity has been considered a risk factor uterine rupture. Retracted uterus extrauterine fetus hemorrhage from torn uterine arteries bleeding into the peritoneal cavity bleeding to the vagina decreased blood volume decreased venous return decreased cardiac. Uterine rupture gynecology and obstetrics merck manuals. We report a case of silent spontaneous uterine rupture, found during a scheduled repeat cesarean section at 36 weeks. Uterine rupture is one of the most severe obstetric complications by high morbidity and maternal and fetal mortality. If the fetus has been expelled from the uterus and is located within the peritoneal cavity, morbidity and mortality increase. The ability of sonographic measurement of the lower uterine segment thickness to predict uterine rupture during a trial of labour in women with a previous caesarean section.
Uterine rupture and its complications in the netherlands. The only factor significantly associated with maternal death in case of uterine rupture after multivariate analysis was coagulopathy ora34. Rupture uterine sur uterus sain au cours dune interruption. The presented case underlines that it is not only a much feared complication during labor but also relevant beyond pregnancy. A study conducted from 1976 to 2005 showed that uterine rupture occurred in one out of 1,514 pregnancies, or 0. Other forms of uterine surgery that result in fullthickness incisions such as a myomectomy, dysfunctional labor, labor augmentation by oxytocin or prostaglandins, and high parity may also set the stage for uterine rupture. Uterine rupture is a lifethreatening pregnancy complication for both mother and fetus. We report a case of silent spontaneous uterine rupture, found during a scheduled repeat cesarean section. Most uterine ruptures in resourcerich countries are associated with a trial of labor after cesarean delivery tolac. Histological examination of the lesion at the site commented that there was infiltration of the chorionic villi into the endometrium, and this is undoubtedly the features of placenta accreta.
Uterine rupture risk factors, complications, causes and. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Risk factors associated with uterine rupture 754 p j m h s vol. Uterine rupture is a serious obstetrical condition associated with maternal mortality. Fortunately, these ruptures are relatively rare events exceedingly rare for women whove never had a csection, other uterine surgery, or a previous rupture. Uterine contraction stops localized tenderness and persisting aching pain over the area of the uterine segment swelling of the abdomen. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. Posterior uterine rupture causing fetal expulsion into the.
Uterine rupture can lead to hysterectomy, urologic injury, the need for blood transfusion, and even the death of the mother and baby. The full text of this article is available in pdf format. Uterine rupture occurred at 25 weeks amenorrhea during pregnancy termination by misoprostol for fetal polykystosis. Nov 21, 2016 uterine rupture is a serious obstetrical condition associated with maternal mortality.589 841 1543 4 1134 99 1304 848 1145 496 1377 756 1051 1310 1015 129 146 1253 572 1227 1085 1007 1409 1325 291 45 1461 693 230 225 975 81 440 1393 120 25 1224 1248 135 1210 992 755 1033 607