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Uterine Rupture

By Julie S. Moldenhauer, MD, Associate Professor of Clinical Obstetrics and Gynecology in Surgery, The Garbose Family Special Delivery Unit; Attending Physician, The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia; The University of Pennsylvania Perelman School of Medicine

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Uterine rupture is spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity.

Uterine rupture is rare. It can occur during late pregnancy or active labor.

Uterine rupture occurs most often along healed scar lines in women who have had prior cesarean deliveries. Other predisposing factors include congenital uterine abnormalities, trauma, and other uterine surgical procedures such as myomectomies or open fetal surgery.

Causes of uterine rupture include

  • Uterine overdistention (multiple gestation, polyhydramnios, fetal anomalies)

  • External or internal fetal version

  • Iatrogenic perforation

  • Excessive use of uterotonics

  • Failure to recognize labor dystocia with excessive uterine contractions against a lower uterine restriction ring

If women who have had a prior cesarean delivery wish to try vaginal delivery, prostaglandins should not be used because they increase risk of 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. If the fetus has been expelled from the uterus and is located within the peritoneal cavity, morbidity and mortality increase significantly.

Diagnosis is confirmed by laparotomy.

Treatment of uterine rupture is immediate laparotomy with cesarean delivery and, if necessary, hysterectomy.