1. RUPTURE OF THE UTERUS

3. DEFINITION
Dissolution of the continuity of the uterine wall any time beyond 28 weeks of pregnancy is called rupture of uterus

4. INCIDENCE
1 in 2000 to 1 in 200

5. ETIOLOGY SPONTANEOUS DURING PREGNANCY (Complete & upper segment)
Previous damage
Grand multiparae
Congenital malformation of the uterus-Bicornuate uterus
Abruptio placentae
DURING LABOUR
Obstructive rupture(Lower segment through lateral side to the upper segment)
Non – obstructive rupture – Grand multiparae(Fundal area and complete)

6. Contd…. SCAR RUPTURE Caesarean section scar
Myomectomy or uteroculoplasty
IATROGENIC
DURING PREGNANCY
Injudicious administration of oxytocin
Use of prostaglandins for induction of abortion or labour
Forcible external version under GA
Fall or blow on the abdomen
DURING LABOUR
Internal podalic version
Destructive operation
Manual removal of the placenta
Application of forceps through incompletely dialated cervix
Injudicious administration of oxytocin for augmentation of labour

7. TYPES Depending on whether peritoneal coat is involved or not
Incomplete peritoneum remains intact
Incomplete rupture occur in the lower segment
Complete rupture occur following disruption of scar in the upper segment

8. DIAGNOSIS DURING PREGNANCY SCAR RUPTURE : Classical or hysterotomy
Dull abdominal pain over the scar area with slight vaginal bleeding
Tenderness on uterine palpation
FHS may be absent
A sense of something is giving way accompanied by acute abdominal pain and collapse

9. Contd…. SPONTANEOUS RUPTURE IN UNINJURED UTERUS
Acute pain with fainting attacks and may collapse
Features of shock
Acute tenderness on abdominal examination
Palpation of superficial fetal parts if rupture is complete
Absence of fetal heart rate

10. Contd…
RUPTURE FOLLOWING FALL, BLOW OR EXTERNAL VERSION OR USE OF OXYTOCICS
Acute pain abdomen
Slight vaginal bleeding
Rapid pulse
Tender uterus

11. Contd… DURING LABOUR SCAR RUPTURE Same as during pregnancy
SPONTANEOUS OBSTRUCTIVE RUPTURE
Signs of obstruction
Pain becomes severe in an attempt to overcome obstruction
Pain becomes sever at the supra pubic region
Dehydrated and exhausted
SPONTANEOUS NON OBSTRUCTIVE RUPTURE
Agonising bruising pain ,relief with cessation of contraction
Shock, internal haemorrhage, tenderness and vaginal bleeding
RUPTURE FOLLOWING MANIPULATIVE OR INSTRUMENTAL DELIVERY
Sudden deterioration of general condition
Shortening of the cord following difficult vaginal delivery

12. PROPHYLAXIS At risk mothers should deliver in the hospital
General anesthesia should not be used in version
Find out the cause for undue delay in labour in multiparae
Judicious selection of cases with previous LSCS for vaginal delivery
Careful watch of patients receiving oxytocin and avoid IM oxytocin
Internal podalic version should not be done in obstructed labour
Avoid forceps delivery or breech extraction in incompletely dialated cervix
Destructive operation should be done by an expert
Attempt to remove placenta accreta should be avoided

13. TREATMENT RESUCITATION LAPAROTOMY Hysterectomy Repair
Repair and sterilisation