The primary objective is to identify tocogram characteristics associated with uterine rupture during trial of labor after cesarean section. The incidence of uterine rupture with vbac was reported to be less than 1% of all attempted vbacs, and serious consequences could be minimized by appropriate intrapartum surveillance. Uterine rupture is a rare peripartum complication associated with severe maternal and perinatal morbidity and mortality,1,2 and is one of the most common clinical causes of medical litigation in the developed world. Caesarean section cs is increasing globally, and women with prior cs are at higher risk of uterine rupture in subsequent pregnancies. Multiparity has been considered a risk factor uterine rupture. Uterine fibroids can appear inside the uterus, on its outer surface or within its wall, or attached to the uterus by a stemlike structure. Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present. Uterine scar rupture prediction, prevention, diagnosis. While rates of uterine rupture vary significantly according to a variety of clinically associated risk factors, the absolute risk for this complication ranges between 0. One of the greatest concerns regarding vbac is the potential for uterine rupture.
Acog practice bulletin minnesota hospital association. Uterine rupture is an obstetric catastrophe that is associated with high maternal and perinatal mortality rates. Studies have reported that the incidence rate of uterine rupture in women who attempt vbac was 9. The risk of uterine rupture during attempted vaginal birth after caesarean section is widely. We report a case of spontaneous uterine rupture during pregnancy at 35 weeks of an unscarred uterus before labour. When compared with rupture of the scarred uterus, however, operating times and mortality rates were similar. Acog american congress of obstetricians and gynecologists. Uterine rupture is a really uncommon and unpredictable event, an emergency condition, which usually takes place in the course of labor, which has a devastating effect on both the mother and the baby. A uterine rupture is a tear that happens at the wall of the uterus, most often in the region where a past csection incision has been made. Medically indicated latepreterm and earlyterm deliveries, regarding delivery for previous uterine rupture. Uterine rupture is a serious childbirth complication that can occur during vaginal birth.
What support services and clinical counseling should be offered to the patient with a stillbirth. These most devastating cases were associated with grande multiparity. Acog says about vbac, so lets get to the facts, straight from the mouth of acog via their latest vbac guidelines. Spontaneous uterine rupture of an unscarred uterus before.
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth. The uterine rupture is a dramatic obstetrical event, fortunately unusual. In april 2002, the acog issued a committee opinion that discourages. Based on the pathophysiology of complete uterine wall separation, changes in uterine activity are expected.
Uterine rupture is a lifethreatening pregnancy complication for both mother and fetus. Uterine rupture occurs most often along healed scar lines in women who have had prior cesarean deliveries. Most ruptures occur in women who have had a previous transmyometrial surgical incision, typically for cesarean delivery. Some of the symptoms of a uterine rupture could be associated with other medical conditions and it is important that care providers make a firm differential diagnosis. Many of the symptoms of uterine rupture are nonspecific. However, one study examining women who gave birth in norway from 1967 to 2008 sought to examine specific risk factors for uterine rupture. By reading this page you agree to acogs terms and conditions.
Uterine rupture during pregnancy is a rare situation. Uterine rupture risk factors, complications, causes and. Uterine distension from multiple gestations is another association with uterine rupture 8,9. Women with an increased risk of uterine rupture who opt for induction of labor should do so with an understanding of the increased risk, and health care providers need to be attuned. It can occur during late pregnancy or active labor.
One factor that markedly influences the likelihood of uterine rupture is the location of the prior incision on the uterus. Uterine rupture is spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity. Planned vbac is contraindicated in women with previous uterine rupture or. Silent spontaneous uterine rupture at 36 weeks of gestation ncbi. Most uterine ruptures in resourcerich countries are associated with a trial of labor after cesarean delivery tolac. Complete uterine rupture is a catastrophic event where a fullthickness tear develops, opening the uterus directly into the abdominal cavity. Previous vaginal delivery decreased the risk of uterine rupture by 60%. Uterine rupture occurs when, during pregnancy, labor, or delivery, there is a tear in the uterus resulting from pressure. Labor is induced to stimulate contractions of the uterus in an effort to have a vaginal birth. Her second pregnancy was complicated by a uterine rupture at 36 weeks of gestation. Following is a summary of the terminology definitions and assumptions found in the 2008 nichd workshop report. As discussed below, the risk of uterine rupture is higher in women with other types of hysterotomies, with the excep tion of low vertical incision a vertical incision performed in the lower uterine segment.
The uterine response to oxytocin depends on the duration of the pregnancy. Current acog guidelines discourage the use of prostaglandins to induce labor in most women with a previous cesarean delivery. Uterine rupture merck manuals professional edition. Unfortunately, onset is often sudden, very often during pregnancy, in the third trimester, and during labor.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Although use of prostaglandins did not increase the risk of rupture, sequential use of a prostaglandin and oxytocin did. Timely diagnosing a uterine rupture is challenging. The uterus can rupture throughout some or all of its layers, compromising the fetus oxygen supply and causing severe bleeding in the mother 1. Uterine rupture is an uncommon complication of pregnancy associated with pote ntially catastrophic consequences for both mother and baby. Labor induction may be recommended if the health of the mother or fetus is at risk. As uterine rupture is a rare complication, few large studies have examined this disease process. The diagnosis is not always obvious and morbidity and maternal and fetal mortality is still high. The risk of uterine rupture among women with a prior cesarean delivery undergoing secondtrimester abortion using misoprostol is less than 0. The secondary objective is to compare the external tocodynamometer with intrauterine. This is an exceptional case that we observe for the first time in our unit. Managing the risk of uterine rupture during a trial of labor after. Predicting uterine rupture in women undergoing trial of.
Rupture of the pregnant uterus, similar to rupture of any internal organ, can be lifethreatening for the mother and fetus. Uterine rupture is the most serious complication for women undergoing trial of labor tol after prior cesarean delivery. In women with an increased risk of uterine rupture eg, history of classical hysterotomy or transfundal surgery, repeat cesarean delivery is a reasonable option. Pdf the uterine rupture is a dramatic obstetrical event, fortunately unusual.
However, little is known about the incidence, risk factors. Uterine rupture survival story teaches two lessons facebook twitter linkedin like having a prior uterine surgery increases the risk of uterine rupture. Prior uterine rupture acog states similar to a history of a prior classical cesarean, the suggested timing of delivery between 36 07 weeks and 37 07 weeks of gestation should be considered but can be individualized based on the clinical situation extensive transfundal uterine surgery. Incidence and outcomes of uterine rupture among women with. Disability or death of the mother or baby may result. Women with an increased risk of uterine rupture who opt for induction of labor should do so with an understanding of the increased risk, and health care providers need to be attuned to signs and symptoms of uterine rupture throughout the labor course.
Whilst the occurrence of uterine rupture is low, it is one of the most lifethreatening obstetric emergencies, with a high rate of both foetal and maternal mortality. Rupture of the intact uterus was characterized by increased blood loss and need for transfusion. In its next statement on vbac in 1994, acog addressed concerns about uterine rupture. Safe prevention of the primary cesarean delivery acog. She asks, when should i be delivered during the current pregnancy. While acog makes every effort to present accurate and reliable information, this publication is provided as is without any warranty of accuracy, reliability, or otherwise, either express or implied. In special situations, labor is induced for nonmedical reasons, such as living far away from the hospital. Nasr a, alnakhli z, iqbal a, al huraibi j, alhazmi j, othman m. Learn more about symptoms, causes, diagnosis, and treatment. Uterine rupture occurs in approximately one of every 67 to 500 women with one prior lowtransverse incision undergoing a trial of labor for vaginal birth after cesarean section.