What is uterine rupture
Release time : 05/08/2025 09:30:02
What is uterine rupture? Uterine rupture refers to a laceration of the body or lower segment of the uterus during childbirth or pregnancy. It is a serious obstetric complication that threatens the life of the mother and child. Is the uterine rupture serious? The uterine rupture is serious and may have a greater impact in the future. Does uterine rupture have a great impact on the future? Yes, uterine rupture may have a greater impact in the future. How to treat uterine rupture? Methods to treat uterine rupture often include surgery and medication. Surgery may be to repair a uterine tear, while medication may include painkillers, antibiotics, etc. Does it have a big impact on the baby? When treating a ruptured uterus, doctors try their best to protect the fetus, but sometimes a Caesarean section may be required. This may have an impact on your baby's health. How can we prevent uterine rupture? To prevent uterine rupture, pregnant women should follow their doctor's advice, maintain a healthy lifestyle, and avoid overwork and stress. In addition, it is important to have regular prenatal examinations. Is uterine rupture a common disease in pregnant women? Yes, uterine rupture is a more common condition among pregnant women. However, as soon as symptoms occur, medical help should be sought immediately as this may be an emergency.
The primary causes of death are hemorrhage, infection, and shock.
With the improvement of obstetrics quality and the establishment and gradual improvement of urban and rural maternal and child health care networks, the incidence rate has dropped significantly.
It is rarely seen in urban hospitals, but it occurs from time to time in rural and remote areas.
There are two types of uterine rupture: (1) Complete uterine rupture: The entire uterine wall splits, and part or all of the amniotic fluid, placenta and fetus are squeezed into the abdominal cavity.
When the rupture occurred, the woman suddenly felt a severe pain like a tear in the abdomen, and then the contraction stopped, and the abdominal pain suddenly subsided.
Soon, as the amniotic fluid, fetus, and blood entered the abdominal cavity, persistent abdominal pain occurred. The mother developed shock symptoms and signs such as pale face, cold sweat, superficial breathing, thin pulses, and dropped blood pressure. Blood may flow out of the vagina, and the amount can be more or less.
The fetal presentation disappears during dispensing and descending, the expanded uterine orifice retracts, and when the anterior wall of the uterus ruptures, the tear can extend forward, causing the bladder to rupture.
Abdominal examination showed tenderness and rebound pain in the entire abdomen. The fetal limbs could be clearly touched under the abdominal wall. The fetal heart sounds disappeared, and the shape of the uterus could not be clearly palpable. Sometimes the shrinking uterine body could be palpable on one side of the carcass. If there is too much intra-abdominal bleeding, you can strike a moving dullness.
Vaginal examination can reveal that the fetal presentation rises, the uterine orifice shrinks, and sometimes the rupture can be palpable in the uterine cavity.
(2)Incomplete rupture: Part or all of the myometrium is ruptured, while the serosa layer remains intact, the uterine cavity is blocked from the abdominal cavity, and the fetus remains in the uterine cavity.
If the tear is in the lower section of the uterine sidewall, a hematoma can form between the two lobes of the broad ligament. If the uterine artery is torn, severe extraperitoneal bleeding and shock can be caused.
Abdominal examination shows that the uterus remains in its original shape, and there is significant tenderness upon palpation. A gradually increasing hematoma can be palpated on one side of the abdomen.
A broad ligament hematoma can also extend upwards to become an abdominal retroperitoneal hematoma.
If bleeding continues, the hematoma may rupture through the serosa, resulting in complete uterine rupture.
Uterine rupture is most commonly associated with difficult labor, advanced maternal age, and cesarean delivery or prior uterine surgery.
Based on the cause of rupture, it can be divided into a scarless uterine rupture and a scarred uterine rupture.
The primary causes include the following: (1) Obstructed labor: Factors such as significant pelvic narrowing, dyscephalic presentation of the fetus, deformities in the pelvic floor, pelvic tumors, and abnormal fetal position impede the descent of the fetal presenting part. In response to resistance, the uterus strengthens its contractions, causing the lower segment of the uterus to be stretched and thinned. This ultimately leads to uterine rupture.
This type of uterine rupture is the most common type, with the rupture occurring mostly at the lower segment of the uterus.
(2) Uterine scar rupture: The causes of the formation of a uterine scar include cesarean section, myomectomy, repair of uterine rupture or perforation, and correction of uterine anomalies.
The cause of rupture is mechanical traction on the pregnant uterus, leading to rupture at the scar or damage to the endometrial tissue in the scar area, placental implantation, and penetration of the placenta causing spontaneous uterine rupture.
In recent years, cesarean section procedures have increased rapidly. Secondary pregnancy through longitudinal incision on the body of the uterus is prone to complications of uterine rupture. The analysis of the reasons not only has the different anatomical properties of the longitudinal incision on the body of the uterus and the lower section transverse incision, but also the role of infection factors is also considered. Because currently, patients who use longitudinal incision on the body of the uterus usually go through a long labor process, and multiple vaginal examinations increase the chance of infection.
(3)Abuse of uterine contractants: The uterine contractants here should include various substances that stimulate uterine contractions, including the most commonly used oxytocin (oxytocin) and misoprostol, which has been used only recently. An increasing number of cases of uterine rupture caused by misoprostol are being reported.
The main reasons include excessive drug dose or too fast administration, immature cervix, irregular fetal position, obstructive dystocia, and careless observation of the labor process during medication.
Injury from vaginal midwifery surgery: The uterine orifice is not fully opened, forced forceps or hip traction, resulting in severe laceration of the cervix and extending to the lower segment of the uterus.
Negligible transverse position, internal version, fetal destruction, partial artificial placenta removal, etc., due to improper operation, can cause uterine rupture.
Uterine malformations and dysplastic uterine wall: The most common is the bicornuate or unicornuate uterus.
Lesions of the uterus itself: polyparia, history of multiple curettage, history of infectious abortion, history of uterine cavity infection, history of artificial detachment of placenta, history of hydatidiform mole, etc.
Due to the above factors, the endometrium and even the muscle wall are damaged, the placenta is implanted or penetrated after pregnancy, and ultimately the uterus is ruptured.
2. Classification: The classification of uterine rupture is based mainly on the causes, timing, location, and extent of rupture.
(1)Classification by rupture cause: ① Spontaneous uterine rupture mostly occurs before delivery, and is common in scar uterus and uterine dysplasia such as bicornuate uterus.
② Traumatic uterine rupture mostly occurs during labor.
(2)Classification according to the time of rupture: ① Uterine rupture during pregnancy is common in scar uterus and uterine dysplasia.
②Uterine rupture during labor is more common in multiparous women, often due to obstructed labor or surgical trauma or improper use of oxytocin (synthetic luteinizing hormone). Most uterine ruptures occur during this period.
(3) According to the location of uterine rupture, it can be classified as follows: ① Uterine body rupture, which is common in cases with scars from previous uterine surgery, placental implantation, and underdeveloped uterus.
2. Uterine rupture at the lower segment is more common in obstructed labor and unsuitable pelvic delivery leading to cervical lacerations and extension.
(4) According to the degree of uterine rupture, it is classified as follows: complete uterine rupture: The entire uterine wall is torn open, and the uterine cavity communicates with the peritoneal cavity. The fetus and placenta may be trapped at the site of uterine rupture or enter the peritoneal cavity. If the gestational age is small, the fetus, amniotic sac, and placenta completely enclose the fetus and enter the peritoneal cavity.
Partial uterine rupture: The myometrium is partially or completely ruptured, with the serosa intact.
Commonly, the lower segment of the uterus ruptures, resulting in a hematoma within the broad ligament, also known as intra-broad ligament myometrial rupture.
Clinical manifestations of uterine rupture can occur in the late stages of pregnancy before labor, but most often during labor when difficulties arise. It is characterized by prolonged labor with the fetus or the presenting part unable to enter the pelvis or being obstructed above the level of the sacral prominence.
Uterine rupture may be divided into two stages: pre-rupture and rupture.
1. Threatened uterine rupture During labor, when the descent of the fetal presentation part is blocked, the powerful contraction causes the lower segment of the uterus to gradually thin and the uterine body to become thicker and shorter, forming an obvious annular depression between the two. This depression will gradually rise to the level of the umbilicus or above, which is called a pathological contraction ring.
At this time, the lower segment is swollen and tender, and the round ligament of the uterus is extremely tense and can be obviously palpable and tender.
The patient complains of severe abdominal pain and restlessness, calling out in distress, with rapid pulse and breathing.
Due to the tight pressure on the bladder at the fetal presentation site, it is congested, dysuria occurs and hematuria occurs.
Due to excessive uterine contractions, fetal blood circulation is obstructed, fetal heart rate changes or becomes inaudible.
This condition, if not relieved promptly, will lead to rupture of the uterus at the site of the pathological retroflexion and below it.
2. Based on the degree of rupture, uterine rupture can be divided into complete and incomplete uterine rupture.
(1) Complete uterine rupture: This refers to the situation where the uterine wall is completely torn, allowing the intrauterine cavity to communicate with the peritoneal cavity.
The moment the uterus completely ruptures, the patient often experiences severe abdominal pain resembling tearing. Subsequently, the uterine contractions cease, and the pain subsides. However, as blood, amniotic fluid, and fetus enter the peritoneal cavity, the patient soon feels full-body pain. The pulse quickens, becomes weak, respiration accelerates, and blood pressure drops.
During examination, there was tenderness and rebound pain in the whole abdomen. The carcass could be clearly touched under the abdominal wall. The uterus shrank to the side of the fetus. The fetal heart disappeared. There may be blood flowing out of the vagina. The amount may be more or less.
The presenting part of the fetus disappears (the fetus enters the abdominal cavity), and the dilated cervix can recoil.
When the anterior wall of the uterus ruptures, the laceration may extend anteriorly to involve the bladder.
Should uterine rupture be diagnosed, it is not necessary to perform a vaginal examination for the rupture site.
If the uterine rupture is caused by the injection of oxytocin, the patient may feel intense contractions of the uterus and sudden severe pain, with the presenting part rising and disappearing suddenly. Abdominal examination will reveal the above mentioned findings.
Uterine scar ruptures can occur during the late stages of pregnancy, but more often during labor.
Initially, there is mild abdominal pain, and tenderness is present at the site of the uterine incision scar. This may indicate that the uterine scar has ruptured, but the membranes have not ruptured, and fetal heart rate is good.
Should not immediate cesarean section be performed, the fetus may enter the abdominal cavity through the rent, producing symptoms and signs similar to those of a uterine rupture.
(2) Incomplete uterine rupture: refers to a condition where the uterine muscle layer is completely or partially ruptured, with the serosa not breached, and the amniotic cavity remains separate from the peritoneal cavity. The fetus and its associated structures are still within the uterine cavity.
Abdominal examination reveals tenderness at the site of partial uterine rupture. If the rupture occurs between the two lobes of the broad ligament, a hematoma can form. At this time, a gradually enlarged and tender mass that can be palpated on one side of the uterus may be present.
The fetal heart sounds are irregular.
How to Prevent Uterine Rupture? Uterine rupture is a common disease among pregnant women, mostly caused by the delivery process. It poses a serious threat to the life of the pregnant woman, so it is important for pregnant women to prevent uterine rupture in time.
Let me introduce to you the preventive measures for uterine rupture.
Prevention of uterine rupture Uterine rupture seriously endangers the lives of mothers and infants, and the vast majority of uterine ruptures can be avoided, so prevention is extremely important.
Strengthen the publicity and implementation of family planning to reduce multiple pregnancies; change the concept of childbirth, advocate natural childbirth, and reduce the rate of cesarean section; strengthen prenatal examinations, correct abnormal fetal position, and estimate that those who may have difficulty in childbirth, or have a history of dystocia, or have a history of cesarean section, should be hospitalized for delivery early, closely observe the progress of the labor process, and decide the delivery method based on obstetric indications and the previous operation.
Strictly grasp the indications, usage, and dosage of oxytocin, and at the same time, special personnel should be assigned to protect it; for pregnant women with uterine scars or uterine malformations, the labor process should be closely observed and the indications for cesarean section should be relaxed.
Closely observe the labor process, and carefully observe the trial labor of pregnant women with high presentation and abnormal fetal position; avoid damaging vaginal midwifery and operations, such as mid-to-high forceps, midwifery before the uterus is fully opened, negligent shoulder presentation for internal version, forced extraction during placenta implantation, etc.
To sum up, the above content describes the prevention methods of uterine rupture, which can keep pregnant women away from uterine rupture. Pregnant women should maintain a good mood, exercise appropriately, and enhance their own resistance.
How to treat uterine rupture? When threatened uterine rupture is discovered, effective measures must be taken immediately to inhibit uterine contraction, such as general anesthesia with ether, intramuscular injection of 100mg of meperidine, etc., to alleviate the process of uterine rupture.
It is best to perform cesarean section as soon as possible, and pay attention to check whether the uterus has ruptured during the operation.
If the fetus is ruptured and has not been delivered, even the stillbirth should not be delivered through the vagina first. This will widen the tear, increase bleeding, and promote the spread of infection. The stillbirth should be removed quickly by laparotomy. Based on the patient's condition, the condition of the tear site, the degree of infection and whether the patient has children, if the uterine tear is easy to suture, the infection is not serious, and the patient's condition is poor, the tear can be repaired and sutured. If there are children, the fallopian tubes are ligated, and if there are no children, their fertility functions are retained.
Otherwise, total or subtotal hysterectomy may be performed.
If the lower segment of the uterus is ruptured, attention should be paid to the bladder, ureter, cervix and vagina. If there is any damage, it should be repaired in time.
Uterine rupture is often accompanied by severe bleeding and infection. Blood transfusions, infusion, sodium lactate should be given before surgery, active anti-shock treatment should be given, and a large dose of broad-spectrum antibiotics should be used to control infection during and after surgery.
The medical part covered in this article is for reading and reference only.
If you feel unwell, it is recommended to seek medical attention immediately, and the medical diagnosis and treatment will be subject to offline diagnosis.