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Uterine Rupture

By

Julie S. Moldenhauer

, MD, Children's Hospital of Philadelphia

Last full review/revision Jul 2021| Content last modified Jul 2021
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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 Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. Up to 30% of deliveries in the US are cesarean. The rate of cesarean delivery fluctuates. It has recently increased, partly... read more . Other predisposing factors include congenital uterine abnormalities, trauma, and other uterine surgical procedures such as myomectomies or open maternal-fetal surgery.

Causes of uterine rupture include

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, fetal and maternal morbidity and mortality increase significantly.

Diagnosis of uterine rupture is confirmed by laparotomy.

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

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Operative Vaginal Delivery
In order to facilitate delivery, operative vaginal delivery involves application of forceps or a vacuum extractor to the fetal head to assist during the 2nd stage of labor. Which of the following is NOT considered an indication for operative vaginal delivery?
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