Endometriosis
Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy in Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Uterine rupture is most commonly described in pregnancy, either before or during labor, in patients who have previously undergone uterine surgery. In particular, if there was full-thickness transection of the contractile portion of the myometrium (eg, fundal myomectomy, classical cesarean delivery), the scar is known to be susceptible to dehiscence. Adenomyosis is a specific subtype of endometriosis in which the ectopic endometrial tissue is found in the myometrium. As these endometrial glands and stroma trigger angiogenesis and continue to respond to systemic and local hormones, they cause inflammation and bleeding in the muscle of the uterus, often resulting in severe dysmenorrhea and menorrhagia. Estimates regarding the prevalence of adenomyosis vary from 25% to 65%, and it often coexists with endometriosis or leiomyomata. Peng et al. describe a case of adenomyosis resulting in spontaneous uterine rupture in a nongravid and unscarred uterus [6].
Cesarean section and vaginal birth after cesarean section
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
The risk of uterine rupture in patients undergoing TLCS varies with the type of previous uterine incision and the number of previous cesarean sections. The risks of uterine rupture range from 0.6% to 0.9% with one previous low transverse uterine incision (19,28,53,54,63–66), 0.7% to 1.8% with more than one previous low transverse uterine incision (53,54,56,57), and is about 12% with a previous classical uterine incision (59). Other predisposing factors include excessive amount of intravenous oxytocin for augmentation or induction of labor, and dysfunctional labor. Fetal macrosomia and epidural anesthesia do not appear to increase the risk of uterine rupture (27). Signs of uterine rupture include abdominal pain, vaginal bleeding, abnormal labor, and abnormal FHR patterns such as sudden onset of prolonged fetal bradycardia and severe variable decelerations (18,67). Trial of labor in patients with previous cesarean sections does not increase maternal mortality compared with those undergoing elective cesarean section (59).
Management after previous caesarean section
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Signs of uterine rupture are: fetal bradycardia;upward displacement of the presenting part;sudden loss of contractions;maternal hypotension;heavy vaginal bleeding;abdominal or shoulder pain.
Successful pregnancy with fundal placenta percreta replacing the myometrial defect from previous uterine rupture
Published in Journal of Obstetrics and Gynaecology, 2019
C. Champion de Crespigny, P. Shetty, E. Inglis, A. Anpalagan, U. Chatterjee, T. I. Alahakoon
Uterine rupture is an obstetric complication associated with significant foetal and maternal morbidity, commonly occurring intrapartum and often requiring a hysterectomy due to a massive haemorrhage. The risk factors include a previous uterine scarring due to caesarean section, myomectomy, perforation, induction of labour, abnormally adherent placenta, foetal macrosomia, multiparity, misuse of oxytocic drugs, instrumental delivery and an advanced maternal age (Cunningham et al. 2018; Kaczmarczyk et al. 2007; Medel et al. 2010; Mizutamari et al. 2014). A case of fundal placenta percreta replacing the myometrial defect from previous uterine rupture is reported, which resulted in a successful pregnancy with delivery via an elective caesarean hysterectomy at 28 weeks of gestation.
Uterine rupture after high-intensity focused ultrasound ablation of adenomyosis: a case report and literature review
Published in International Journal of Hyperthermia, 2023
Yinxia Liu, Na Fu, Bin Lv, Yuedong He, Xiaoli Wang
The preferred gestational age for delivery and indications for vaginal delivery or cesarean section remain controversial. However, various studies have indicated the safety of vaginal delivery in women with previous HIFU treatment [8,9]. Based on our experience, patients with unplanned pregnancies after aggressive HIFU treatment should reduce activities in late pregnancy and live close to the hospital in case of medical emergencies. Pelvic MRI during the third trimester may be helpful for evaluating the thickness of the uterine wall, particularly the ablated area by HIFU treatment. It is necessary to admit to hospital when uterine contractions were observed. Inexplainable abdominal pain and fetal intrauterine distress could be signs of uterine rupture. After delivery to the fetus and placenta, the entire uterus, specifically the areas receiving HIFU treatment, should be carefully examined for local weakness or rupture.
A case of a contained uterine rupture
Published in Journal of Obstetrics and Gynaecology, 2019
Although uterine scar rupture is rare, it may have catastrophic consequences for the mother and foetus (Kieser and Baskett 2002). The reported incidence of uterine rupture varies. One study found there was a rate of uterine rupture of 0.52% for spontaneous labour, 0.77% for a labour induced without prostaglandins and 2.24% for a prostaglandin-induced labour (Lydon-Rochelle et al. 2001). The relative risk of rupture has been found to be increased in the instances of labour induction and/or augmentation versus a spontaneous labour, especially when sequential agents are employed (Macones et al. 2005). It is usually suspected during labour when there is heavy vaginal bleeding or when changes in the foetal heart rate patterns occur (Ridgeway et al. 2004, Ouzounian et al. 2014, Vachon-Marceau et al. 2016). This finding can be confirmed during a manual inspection of the uterine scar vaginally after a delivery or during an emergent caesarean section.
Related Knowledge Centers
- Childbirth
- Cocaine
- Uterine Contraction
- Uterus
- Pregnancy
- Delivery After Previous Caesarean Section
- Obstructed Labour
- Labor Induction
- Injury
- Wound Dehiscence