a disruption of the uterine wall (full-thickness myometrial tear) typically associated with contractions.
| Risk factors | • Prior uterine surgery (eg, cesarean delivery, myomectomy) (MCC) • Induction of labor/prolonged labor • Congenital uterine anomalies • Fetal macrosomia • Short Interpregnancy • Advanced maternal age (≥35) | | --- | --- | | Clinical presentation | • Vaginal bleeding • Intraabdominal bleeding (hypotension, tachycardia) • Fetal heart decelerations • Loss of fetal station • Palpable fetal parts on abdominal examination (palbable irregular protuberance in th lower abdomen) • Loss of intrauterine pressure | | Management (Emergency) | • Laparotomy for cesarean delivery & uterine repair (high risk of fetal demise and maternal hemorrhagic shock) |
When the uterus ruptures, the sudden decrease in intrauterine pressure and partial fetal delivery into the maternal abdomen can result in loss of fetal station(eg, 0 to −3 station).
. The presentation of uterine rupture varies based on the extent and exact location of the rupture and the presence or absence of regional anesthesia.
severe, sudden-onset abdominal pain and vaginal bleeding; patients may have a palpable, irregular abdominal mass (ie, protruding fetal parts) and fetal decelerations due to fetal hypoxia and cord compression. Additional findings may include loss of fetal station and change in contraction pattern (eg, decreased uterine tone).
Patients with uterine rupture may have changes in contraction pattern and uterine tone (eg, increased or decreased); however, continued contractions (as in this patient) are not uncommon. An abnormal fetal heart rate tracing is often the first sign of uterine rupture and can present as bradycardia, late decelerations, or variable decelerations.
A significant risk factor for uterine rupture is prior uterine surgery, particularly a prior classical cesarean delivery because it creates a scar in the upper uterus (ie, near the fundus). The myometrium in the upper uterus is thick and contracts forcefully during labor. In patients with a prior classical cesarean delivery, the inelastic scar may not withstand increasing uterine distension or labor contractions, resulting in uterine rupture.
A short interpregnancy interval (eg, <6-18 months from last delivery) may increase the risk of uterine rupture due to insufficient time for uterine healing in patients who underwent cesarean delivery.
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weakened uterine scar tissue can separate with the force of contractions.
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“stair case sign of uterine contractions”