Ruptured Uterus
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ICD10 CODE: O71.1
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, 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.
Treatment | LOC |
|
HC3 H |
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