OG14.2 | Rupture Uterus — Summary & Reflection

KEY TAKEAWAYS

Uterine rupture is a complete or incomplete tearing of the uterine wall during pregnancy or labour, classified by cause as scarred (previous CS, myomectomy, classical incision) or unscarred (obstructed labour, grand multiparity, injudicious oxytocin). Complete rupture presents with sudden cessation of contractions, maternal haemodynamic collapse, loss of uterine contour, absent fetal heart, and haematuria. Scar dehiscence may be silent, detected only by CTG changes or scar tenderness. Diagnosis is clinical — no time for imaging. Management is simultaneous resuscitation (large-bore IV, crossmatch, rapid fluids) and emergency laparotomy. At surgery: repair is appropriate for small clean tears; subtotal or total hysterectomy for extensive rupture with haemorrhage. Prevention centres on risk stratification of scarred uteruses: classical CS scar = absolute contraindication to VBAC (rupture risk 4–9%); single transverse LUS scar = VBAC possible with continuous CTG and 30-minute CS capability. Injudicious oxytocin and neglected obstructed labour remain the dominant preventable causes in low-resource settings.

REFLECT

Consider the clinical dilemma facing an obstetrician who has a VBAC labour progressing well: the woman is at 7 cm, the CTG is normal, and suddenly there is a prolonged deceleration. How do you weigh the next 5 minutes? What would your decision be if the CTG recovers after 4 minutes — continue, or proceed to CS? Now reflect on the systemic factors: does your future practice hospital have 24-hour emergency CS capability? What happens to a VBAC patient who ruptures in a facility without immediate surgical capability? How should the system be designed to prevent that scenario?