Spontaneous Uterine Rupture During Pregnancy

Abstract

Uterine rupture is an uncommon but potentially life-threatening obstetrical emergency, occurring in 1 on 1200 to 1 on 5000 deliveries. It is more frequent in developing countries and in low-resource area. Rupture of the uterus in women without a history of cesarean section is rare, with a reported incidence of 0.02%. Incidence of uterine rupture is affected by the level of medical care and the presence of scar in the uterus. While asymptomatic uterine dehiscence rarely results in adverse fetal outcome, the complete uterine rupture with extrusion of the placenta or the fetus in the abdomen can be catastrophic. Generally, uterine rupture refers to a complete separation of all uterine layers, including the uterine serosa. It threatens the life of both the mother and fetus, with devastating maternal complications, including need for blood transfusion, intra-abdominal hemorrhage, and peripartum hysterectomy. Maternal mortality is 0.44%, and it resulted from hemorrhage, shock, sepsis, disseminated intravascular coagulation, pulmonary embolism, ileus paralyticus, peritonitis, and renal failure. Fetus may experience lifelong consequences, especially newborns, with lower Apgar scores and at higher risk for peripartum mortality: The perinatal mortality after uterine rupture is reported as ranging from 74% to 92%, in less developed countries. Uterine rupture generally occurs in women with previous cesarean section, during labor, or in patients with a scarred uterus. The risk factors are probably sequential labor induction, second-stage dystocia, labor augmentation, preterm delivery, delivery after 42nd gestational week, grand multiparity, previous uterine manipulations (such as curettage), instrumental delivery and external trauma, and fetal malpresentation. Initial treatment in a case of uterine rupture should be aimed at stabilization of the patient, with aggressive replacement of fluid with crystalloid and blood products. Early diagnosis and deciding to proceed with surgical intervention can be lifesaving. The aim of management should be to stop the hemorrhage, repair the anatomic damage, and reduce morbidity with surgical repair or a hysterectomy, depending on several factors such as the size of the uterine defects, patient age, and comorbidities.