Pregnancy and childbirth are very important phases in the life of a woman but not all women have safe pregnancy and delivery. Several complications may occur during pregnancy and childbirth which risks the life of a mother and baby.
Rupture of the uterus is one of the most serious complications which may occur during pregnancy and childbirth. It is a significant problem worldwide and fatal for the foetus and also responsible for the death of the mother. This condition can be avoided with effective antenatal and intrapartum care.
What is rupture of the uterus?
Rupture of the uterus is a life-threatening condition that involves a tear in the wall of the uterus with or without expulsion of the foetus in the abdomen, which endangers the life of both mother and baby.
It is an emergency condition that occurs during labour and less in pregnancy. It can be a complete ( tearing of the uterus with the expulsion of the fetus in the abdomen) or an incomplete one (tearing of uterine wall but not perimetrium). It affects 1 in 500 childbirths.
What are the causes of rupture of the uterus?
The causes of rupture of the uterus include
- A woman with multiple births or high parity.
- Cephalo pelvic disproportion due to contracted pelvis causes obstructed labour which may lead to rupture of the uterus.
- It occurs in a woman with a previous uterine scar from cesarean delivery
- During labour, pressure builds as the foetus passes through the mother’s birth canal and causes the tear of the uterus.
- Giving excessive fundal pressure during the delivery process
- Excessive use of oxytocin where the mother is of high parity
- The use of prostaglandins to induce labour in the presence of an existing scar may cause tearing of the uterus
- Any previous injury to the uterus due to forceps, uterine curettage, perforation of the uterus during dilatation and curettage procedure, previous uterine surgeries and previous manual removal of the placenta
- Previous injury to the uterus as a result of an accident
- Neglected vaginal labour when there is a previous history of caesarean section
- Shoulder dystocia
- Manipulation such as external or internal version in the presence of a previous uterine scar may lead to a rupture uterus.
Due to the above-mentioned causes, the uterus may tear and the content of the uterus with or without a baby may spill into the peritoneal cavity and abdomen of the mother and endangers their life.
What are the signs and symptoms of rupture uterus?
The following are signs and symptoms of uterine rupture-
- Severe abdominal pain
- Pain over the scar area
- Mother’s pulse rate increases with low blood pressure
- Presence of vaginal bleeding
- Fetal heart sound may be absent or irregular
- Sudden collapse of the mother and chances of shock
- Poor progress in the labour
- Stoppage of uterine contractions
- Two separate swellings over the abdomen can be seen, one contracted uterus and other of the foetus.
- Recession of the presenting part during labour
- Palpation of superficial foetal parts
- Acute tenderness on abdominal examination.
How is rupture uterus diagnosed?
Uterine rupture is difficult to diagnose because it occurs suddenly. Laparotomy is the only way to diagnose the condition. The diagnosis may be established by the symptoms of shock, palpation of superficial fetal parts, absence of fetal heart rate and acute tenderness on abdominal examination. Doctor can make the only official diagnosis based on the presence of symptoms until surgery is done.
How is rupture uterus treated?
Depending upon the condition of the woman, resuscitation is to be done followed by laparotomy.
An immediate caesarean section is performed, in the hope of delivering a live baby. After the delivery of baby and the placenta, the extent of the rupture can be assessed to make choice between the options to perform a hysterectomy (uterus removal) or to repair the rupture depends on the extend of the injury and the mother’s condition.
The woman may need a blood transfusion in case of excessive blood loss and management of shock is done.
How can uterine rupture be prevented?
The only way to prevent the uterine rupture is to detect at the earliest the possibility of the rupture uterus.
- The at-risk women should have a caesarean delivery.
- If there is a delay in the progress of labour in a woman with multiple births, the cause should be identified without any delay.
- To prevent any injury to the uterus, procedures like forceps delivery, manual removal of the placenta and dilatation and curettage should be performed by a skilled doctor.
If you had any uterine rupture during pregnancy or childbirth, then you should wait for at least 9 to 12 months to go for the next pregnancy. When you have completely recovered from rupture uterus and pregnant again then you should report about pregnancy to your health care provider, so that preventive measures can be adopted to prevent a recurrence. It is very important to discuss with the healthcare provider about the previous surgery done for a rupture uterus so that you can make the best decision for you and your baby. After complete recovery from the rupture uterus, you can have a normal pregnancy with a healthy baby.
In the above post, we discussed the rupture of the uterus, its causes, symptoms, diagnosis and treatment.