Understanding Uterine Rupture in Midwifery

1. Rupture of the uterus

2. -the most serious complications in midwifery and obstetrics. • -It is often fatal for the fetus and may also be responsible for the death of the mother. • - It remains a significant problem worldwide. With effective antenatal and intrapartum care some cases may be avoided. • Rupture of the uterus is defined as being • 1-complete • 2-incomplete:

3. • complete rupture involves a tear in the wall of the uterus with or without expulsion of the fetus • • incomplete rupture involves tearing of the uterine wall but not the perimetrium. • -Dehiscence of an existing uterine scar may also occur. • - This involves rupture of the uterine wall but the fetal membranes remain intact. • - The fetus is retained within the uterus and not expelled into the peritoneal cavity

4. Causes • - spontaneous rupture of an unscarred uterus in primigravid mothers but are rare. • Precipitating factors; • • antenatal rupture of the uterus, where there has been a history of previous classical caesarean section • • neglected labour, where there is previous history of caesarean section • • high parity • • use of oxytocin, particularly where the mother is of high parity • • use of prostaglandins to induce labour, in the presence of an existing scar

5. obstructed labour: the uterus ruptures owing to excessive thinning of the lower segment • • extension of severe cervical laceration upwards into the lower uterine segment • -the result of trauma during an assisted birth • • -trauma, as a result of a blast injury or an accident • • perforation of the non-pregnant uterus can result in rupture of the uterus in a subsequent pregnancy

6. Signs of intrapartum rupture of the uterus • -Complete rupture of a previously non-scarred uterus may be accompanied by sudden collapse of the mother, who complains of: • 1- severe abdominal pain. • 2-The maternal pulse rate increases; • 3- alterations of the fetal heart may occur, including the presence of variable decelerations • 4- intrapartum fetal deaths associated with ruptured uterus

7. 5-There may be evidence of fresh vaginal bleeding. • 6- The uterine contractions may stop and the contour of the abdomen alters. • 7-The fetus becomes palpable in the abdomen as the presenting part regresses. • 8-The degree and speed of the mother's collapse and shock depend on the extent of the rupture and the blood loss

8. Signs of rupture of uterus • • Abdominal pain or pain over previous c/s scar • • Abnormalities of the fetal heart rate and pattern • • Vaginal bleeding • • Maternal tachycardia • • Poor progress in labour

9. Incomplete rupture of the uterus • have an insidious onset • found only after birth or during a caesarean section. • This type is more commonly associated with previous caesarean section. • Blood loss associated with dehiscence, or incomplete rupture, can be scanty, as the rupture occurs along the fibrous scar tissue which is avascular • shock during the third stage of labour is severe • the mother fails to respond to treatment given, • Incomplete rupture may also be manifest as a cause of abdominal pain and or postpartum hemorrhage following vaginal birth.

11. Management • -An immediate caesarean section is performed in the hope of delivering a live baby. • - Following the birth of the baby and placenta, the extent of the rupture can be assessed. • -Choice between the options to perform a hysterectomy or to repair the rupture depends on the extent of the trauma and the mother's condition. • -Further clinical assessment will include evaluation of the need for blood replacement and management of any shock. • -The mother will be unprepared for the events that have occurred and therefore may be totally opposed to hysterectomy. • -Reports of successful pregnancy following repair of uterine rupture are available

12. Rupture of the uterus following previous caesarean section • -The risk of uterine rupture is increased for those women who have a uterine scar. • - Rates of rupture are lowest following a lower segment caesarean section.