Uterine rupture

Uterine rupture

Anesthetic relevance
Anesthetic management	{{{anesthetic_management}}}
Specialty
Signs and symptoms
Diagnosis
Treatment
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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.

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.