Uterine Rupture" The Silent and Most Dangerous Threat for Pregnant Mothers

Uterine Rupture is a critical obstetric emergency and one of the most terrifying complications. The incidence of uterine rupture during pregnancy is rare, approximately 0.07% of all deliveries. Although it is uncommon, it is life-threatening for both the mother and the fetus. Uterine rupture occurs when the uterine wall tears through all its layers, causing significant internal bleeding into the abdominal cavity. The fetus and amniotic fluid may spill into the abdominal cavity, or the fetus may die in utero. It is an obstetric emergency that requires immediate surgical intervention to save both the mother and the fetus.

 

Who is at High Risk for Uterine Rupture During Pregnancy?

Women with risk factors for uterine rupture during pregnancy include

Factors That Increase the Risk of Uterine Rupture

 - Congenital Uterine Abnormalities: This can weaken parts of the uterine muscle, making it more susceptible to rupture, especially during pregnancy or when medications to stimulate uterine contractions are used for childbirth.

 - Previous Uterine Surgery: Past surgeries on the uterine muscle, such as fibroid removal, can weaken the uterine wall, increasing the risk of rupture during pregnancy.

 - History of Uterine Rupture: If a woman has previously experienced a uterine rupture, the risk of it happening again during a subsequent pregnancy increases.

 - Previous Cesarean Sections: Women who have had a cesarean delivery have a 15-30 times greater risk of uterine rupture in subsequent pregnancies. The risk increases with the number of cesarean sections; for example, one prior cesarean increases the risk by 0.6%, and two prior cesareans raise it by 1.8%. The type of incision made during the cesarean also affects the risk, with vertical incisions having a higher chance of rupture than low transverse incisions.

 - History of Multiple D&C (Dilation and Curettage): Multiple D&C procedures before pregnancy can thin the uterine wall, increasing the risk of rupture during pregnancy.

 - Having Multiple Children: Multiple pregnancies can weaken the uterine muscle, increasing the risk of rupture in future pregnancies.

 - Excessive Uterine Expansion: Conditions like multiple pregnancies (twins), or pregnancy with fibroids, can cause the uterus to expand more than normal, weakening the uterine muscle and increasing the risk of rupture.

 - Large Baby: A larger fetus can cause intense uterine contractions during labor, increasing the risk of uterine rupture.

 - Abnormal Fetal Positioning: A fetus in a transverse lie, for example, can prevent normal labor progression, increasing the likelihood of uterine rupture due to excessive contraction attempts.

 - Excessive Use of Uterine Stimulants: Overuse of medications to induce labor can lead to excessive uterine contractions, increasing the risk of rupture.

 - Assisted Deliveries or Surgical Interventions: Using forceps, or performing maneuvers to turn the baby in the womb, can increase the risk of uterine rupture.

 - Obstructed Labor: Labor that takes longer than usual or is complicated can increase the chances of uterine rupture.

 - Severe Trauma: Any severe impact or injury to the uterus can increase the risk of rupture.

 

Warning Signs of a "Uterine Rupture"

 - Sudden severe abdominal pain or a sensation of something "tearing" in the abdomen

 - Abnormal uterine contractions or a sudden stop in contractions

 - Abnormal vaginal bleeding (in some cases, there may be no external bleeding as the blood is inside the abdomen)

 - Low blood pressure, feeling dizzy, faint, cold hands, palpitations, and shock due to blood loss

 - Abnormal fetal heart rate, such as a decrease in heart rate or no heartbeat detected at all

 

How Do Doctors Diagnose Uterine Rupture in Pregnant Women?

Doctors diagnose uterine rupture in pregnant women by:

1.Medical History: This includes risk factors, as mentioned earlier, or in cases where the doctor has administered medications to stimulate uterine contractions to accelerate labor. If the patient experiences severe labor pain followed by symptoms such as dizziness, fainting, sweating, palpitations, cold hands and feet, and pale eyelids, it may indicate uterine rupture.

2.Physical Examination:

     For the Mother: Early symptoms may be difficult to distinguish from general labor pain. However, if there is significant bleeding in the abdomen, the patient's symptoms become more evident, such as changes in vital signs (increased pulse rate, low blood pressure due to significant blood loss, firm and tense abdomen, severe pain when the doctor palpates the abdomen, and shock).

     For the Fetus: The baby may be palpable but the uterus cannot be felt. The most common and earliest sign is abnormal fetal heart rate, especially a sudden drop in heart rate due to insufficient blood supply to the baby. If the fetal heart rate cannot be heard, and if the rupture is large and the baby has expelled from the uterus, the fetus may not survive.

3.Ultrasound: Ultrasound can help diagnose uterine rupture in cases where the symptoms in both the mother and the fetus are not yet clear and stable. It helps assess the health and position of the fetus, check for fluid or blood in the abdomen, and evaluate the condition of the uterus.

 

How to Treat Uterine Rupture in Pregnant Women?

 

     The treatment guidelines according to ACOG and AAFP (American College of Obstetricians and Gynecologists and American Academy of Family Physicians) emphasize the importance of rapid emergency cesarean delivery to save the baby from oxygen deprivation. The original goal is to complete the process from decision to incision within 30 minutes. Case studies have shown that timely fetal rescue is related to the speed of the surgery (in some cases, the average time should not exceed 17-18 minutes) to prevent maternal and fetal death or disability. The treatment of uterine rupture depends on several factors, such as the size and depth of the tear, the severity of maternal blood loss, and the desire for future fertility.

 - In cases where the mother does not lose much blood, the tear is small, and she desires future pregnancies, the doctor usually performs a repair to preserve the uterus.

 - In severe cases with multiple tears, significant maternal blood loss, and instability, the doctor may need to remove the uterus to save the life of the mother and baby.

 

How to Prevent Uterine Rupture in Pregnant Women

Uterine rupture in pregnant women can be prevented by:

 - Early and regular prenatal care: Follow the doctor's advice strictly.

 - Limit the number of pregnancies: If you have had a cesarean section, having more than two C-sections increases the risk of uterine rupture. The American College of Obstetricians and Gynecologists (ACOG) recommends no more than three C-sections.

 - Allow a gap of at least 1.5 to 2 years between pregnancies after a cesarean to allow the uterine incision to heal properly.

 - Always inform your obstetrician if you have had any previous uterine surgery or procedures, such as fibroid removal or dilation and curettage (D&C).

 - Watch for warning signs: If you experience sudden severe abdominal pain, vaginal bleeding, or notice a decrease in fetal movement, contact your doctor immediately.

 

Can a Woman Get Pregnant Again After a Uterine Rupture?

     If the uterus is not removed, a woman can still get pregnant. However, it is recommended to wait at least 1.5 to 2 years before trying to conceive again to allow the uterine scar to fully heal. For subsequent pregnancies, a cesarean section will be necessary to prevent the risk of the old uterine scar rupturing again.

     Uterine rupture is a critical condition that can be prevented. Phitsanulok Phichit Hospital advises all mothers to have regular prenatal check-ups and inform their obstetrician about any previous surgeries in detail, so that the doctor can monitor and plan the safest delivery for both mother and baby.

 

 

Source : Phitsanuvej Phichit Hospital

**Translated and compiled by ArokaGO Content Team