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Uterine Rupture

by Julie S. Moldenhauer, MD

Uterine rupture is rare. It 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. Uterine rupture can occur before or during labor.

Causes of uterine rupture include uterine overdistention (multiple gestation, polyhydramnios, fetal anomalies), external or internal fetal version, iatrogenic perforation, excessive use of uterotonics, and 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 include fetal bradycardia, variable decelerations, evidence of hypovolemia, loss of fetal station (detected during cervical examination), and severe or constant abdominal pain.

Diagnosis is confirmed by laparotomy. If the fetus has been expelled from the uterus and is located within the peritoneal cavity, morbidity and mortality increase significantly.

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

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