Difference between revisions of "Uterine rupture"
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Uterine rupture is a rare complication of pregnancy usually occurring along healed scar lines in the uterus in women who have had prior cesarean deliveries. It usually occurs in late pregnancy or during active labor. | |||
== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> == | == Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> == | ||
=== Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> === | === Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> === | ||
In patients attempting a trial of labor after C-section (TOLAC), particular attention must be paid to the risk of uterine rupture, especially as it may present differently with or without an epidural in place. | |||
=== Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> === | === Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> === | ||
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== Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> == | == Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> == | ||
Causes of uterine rupture include uterine overdistension (multiparity, polyhydramnios, fetal anomalies), external or internal fetal version, iatrogenic perforation, excessive use of uterotonics, or failure to recognize labor dystocia. These potential etiologies are significantly more likely to cause rupture in the setting of an existing uterine scar. | |||
== Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. --> == | == Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. --> == | ||
* Fetal bradycardia | |||
* Variable decelerations | |||
* Evidence of hypovolemia | |||
* Loss of fetal station | |||
* Severe or constant abdominal pain | |||
== Diagnosis<!-- Describe how this comorbidity is diagnosed. --> == | == Diagnosis<!-- Describe how this comorbidity is diagnosed. --> == | ||
Confirmed by laparotomy | |||
== Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. --> == | == Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. --> == | ||
Uterine rupture is treated with immediate laparotomy with cesarean delivery and, if necessary, hysterectomy. | |||
== Epidemiology<!-- Describe the epidemiology of this comorbidity --> == | == Epidemiology<!-- Describe the epidemiology of this comorbidity --> == | ||
Latest revision as of 14:00, 20 October 2022
Uterine rupture
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Uterine rupture is a rare complication of pregnancy usually occurring along healed scar lines in the uterus in women who have had prior cesarean deliveries. It usually occurs in late pregnancy or during active labor.
Anesthetic implications
Preoperative optimization
In patients attempting a trial of labor after C-section (TOLAC), particular attention must be paid to the risk of uterine rupture, especially as it may present differently with or without an epidural in place.
Intraoperative management
Postoperative management
Related surgical procedures
Pathophysiology
Causes of uterine rupture include uterine overdistension (multiparity, polyhydramnios, fetal anomalies), external or internal fetal version, iatrogenic perforation, excessive use of uterotonics, or failure to recognize labor dystocia. These potential etiologies are significantly more likely to cause rupture in the setting of an existing uterine scar.
Signs and symptoms
- Fetal bradycardia
- Variable decelerations
- Evidence of hypovolemia
- Loss of fetal station
- Severe or constant abdominal pain
Diagnosis
Confirmed by laparotomy
Treatment
Uterine rupture is treated with immediate laparotomy with cesarean delivery and, if necessary, hysterectomy.