RUPTURED UTERUS

Partial or complete tearing of the uterus, common in:

  • Multiparous women (i.e. have had >1 live babies)
  • Women with previous caesarean section

Causes/predisposing factors

  • Assisted deliveries/obstetric procedures
  • Neglected obstructed labour
  • Tearing of a poorly-healed uterine scar during labour
  • Short interpregnancy interval of less than 18 months after Caeserean Section
  • Previous history of uterine surgery, e.g. myomectomy
  • Damage to uterus due to a blow, e.g. kick or accident
  • Use of oxytocic herbs

Clinical features

  • Cessation of regular uterine contractions (labour pains)
  • Continuous abdominal pain
  • Vaginal bleeding
  • Anxiety, anaemia, and shock
  • Abdomen is irregular in shape
  • Foetal parts easily felt under the skin if the foetus is outside uterus and foetal heart is not heard

Differential diagnosis

  • Abruptio placentae
  • Placenta praevia
  • Other causes of acute abdomen in late pregnancy
  • Ruptured spleen
  • Bowel obstruction

Investigations

  • Blood: CBC, grouping and cross-matching

MANAGEMENT

Mothers with a suspicion of ruptured uterus should be referred immediately to hospital for blood transfusion and
surgical management.

  • Set up IV normal saline infusion
  • Give IV ceftriaxone 2 g and IV metronidazole 500 mg stat then
  • Refer to hospital immediately for surgical management (cesarean section ± hysterectomy)

Prevention

  • Good ANC and education on early arrival to the facility for labour and delivery
  • Skilled birth attendance at all deliveries
  • Careful monitoring of labour using a partogram
  • Minimise the use of oxytocin in multiparous women
  • Do not attempt fundal pressure during labour
  • DO NOT use misoprostol for induction of labor