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A Case Series of Uterine Rupture: Lessons to be Learned for Future Clinical Practice

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Abstract

Objective

In this article, we try to discuss risk factors and diagnostic difficulties for uterine rupture.

Methods

Case series of 12 cases of uterine rupture observed in the Norfolk and Norwich University Hospital in the UK, with an average yearly birth rate of 6,000 deliveries, over a 6-year period.

Results

In the present case series, there was no maternal mortality, and uterine rupture was a rare occurrence (12 in 36,000 births). Uterine rupture is associated with clinically significant uterine bleeding, fetal distress, expulsion or protrusion of the fetus, placenta or both into the abdominal cavity, and the need for prompt cesarean delivery and uterine repair or hysterectomy. The risk factors for rupture include previous cesarean sections, multiparity, malpresentation and obstructed labor, uterine anomalies, and use of prostaglandins for induction of labor. Previous cesarean section is, however, the most commonly associated risk factor. The most consistent early indicator of uterine rupture is the onset of a prolonged, persistent, and profound fetal bradycardia.

Conclusion

In this case series, we suggest that the signs and symptoms of uterine rupture are typically nonspecific, which makes diagnosis difficult. Delay in definitive therapy causes significant fetal morbidity. The inconsistent signs and the short time in prompting definitive treatment of uterine rupture make it a challenging event. For the best outcome, vaginal birth after previous cesarean section needs to be looked after in an appropriately staffed and equipped unit for an immediate cesarean delivery and advanced neonatal support.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Vladimir Revicky (Specialty Registrar), Aruna Muralidhar (Specialty Registrar) & Sambit Mukhopadhyay (Consultant)

  2. Office of Research and Clinical Audit, Lindsay Stewart R&D Centre, Royal College of Obstetricians & Gynecologists, 27 Sussex Place, Regent’s Park, London, NW1 4RG, UK

    Tahir Mahmood (Reviewer and Research Facilitator)

Authors
  1. Vladimir Revicky
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  2. Aruna Muralidhar
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  3. Sambit Mukhopadhyay
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  4. Tahir Mahmood
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Corresponding author

Correspondence to Tahir Mahmood.

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Revicky, V., Muralidhar, A., Mukhopadhyay, S. et al. A Case Series of Uterine Rupture: Lessons to be Learned for Future Clinical Practice. J Obstet Gynecol India 62, 665–673 (2012). https://doi.org/10.1007/s13224-012-0328-4

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  • DOI: https://doi.org/10.1007/s13224-012-0328-4

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