Uterine rupture is the most serious complication of childbirth. The effects of this pathology concern the mother and the child, which further adds to the dramaturgy of this clinical situation. Fortunately, it is one of the rare obstetric pathologies observed mainly among multiparous women, usually after the age of 30-40. What are the causes and symptoms of uterine rupture?
Uterine ruptureoccurs spontaneously or as a result of trauma, usually during childbirth, but sometimes during pregnancy, when the uterine muscle grows in size. Therefore, it is extremely important to care for the woman in labor so that the symptoms of uterine rupture are not overlooked. The time of medical intervention in such a situation is very important and may save the lives of the woman and the child.
Uterine rupture: types
Medical nomenclature distinguishes three types of uterine rupture:
- spontaneous rupture of the uterus- it occurs during pregnancy, when the size of the uterus is enlarged or already in the delivery room during labor contractions. In the latter situation, the cause is not fully known. Many people believe that the etiology of spontaneous uterine rupture is associated with pathological changes within the uterine muscle. These include postoperative scars (after cc), condition after removal of uterine fibroids, history of ingrown placenta or uterine hypoplasia.
- traumatic rupture- this type of uterine rupture is the result of improper obstetric surgery. Incompetent procedures are a consequence of the lack of experience of doctors resulting from the rare occasion of performing this type of intervention (rotation of the fetus in the event of an incorrect position, manual extraction of the placenta or forceps delivery).
- retractive rupture of the uterus- this is the effect of birth disproportionate, i.e. disproportionate dimensions of the fetus to the dimensions of the labor pelvis. Such a situation makes childbirth by means of natural means impossible, and a prolonged decision to terminate a cesarean section may result in uterine rupture due to long-lasting contractions of the uterus. Lack of progress in labor is diagnosed not only in the case of disproportion, but also in the case of improper position of the fetus: transverse or gluteal.
Touterine rupture usually occurs in the lower midline or transversely, but it is not uncommon with post-operative scars that detachment of the uterine body is observed along the scar line. Due to the various traumatization of tissues and adjacent structures, a complete rupture is distinguished, when, apart from the uterine muscle, there is a break in the peritoneal continuity, which results in the fetal displacement into the peritoneal cavity, and an incomplete rupture when the peritoneum is not broken.
Symptoms of uterine rupture
Uterine rupture is preceded by prodromal symptoms, i.e. symptoms that may indicate a threat. Therefore, careful observation of the woman in labor plays an invaluable role and enables prompt intervention. During uterine contractions, the patient reports severe pain in the lower abdomen, which does not disappear during the pause between contractions. An attentive observer will also notice the increased tension of the round ligaments of the uterus, shining through the abdominal wall. Occasionally, general symptoms may occur, such as a slight increase in body temperature or an increased heart rate. However, it should be emphasized that this is an individual matter and not all ailments occur simultaneously in every woman.
The symptoms described above refer to the risk of uterine rupture. If the process is complete, severe abdominal pain is predominant and appears suddenly. The severity of pain is so great that in many cases the contraction is interrupted. The woman in labor gradually goes into a state of shock: threadlike pulse, pale skin, increased sweating. On palpation, the uterus is constricted and the parts of the fetus are examined by the doctor within the peritoneal cavity.
Treatment of uterine rupture
Due to the advancement of uterine rupture, the therapeutic procedures differ. When there is a risk of uterine rupture, management involves the rapid administration of antispasmodics. Then, the childbirth initiated by means of natural means and ways is subject to inversion to caesarean section.
In the more tragic version, when the rupture is complete, parts of the fetus are in the peritoneum, the only solution is to open the abdominal wall, extract the fetus, and sew the ruptured uterus, and sometimes remove it when the rupture is severe. The bleeding is usually so great that it requires a blood transfusion.