Rugilė Dubickaitė1, Martyna Šopauskienė1, Julius Piluckis1
1Lithuanian University of Health Sciences, Academy of Medicine, faculty of Medicine
The growing rates of caesarean section and frequently used pharmacological labour induction increase the risk of labour complications. Uterine rupture is rare, although life threatening condition for both mother and fetus. The main risk factors of uterine rupture include previous uterine rupture, scar after previous caesarian section and the use of prostaglandins and oxytocin for labour induction. The risk is even higher when there are more than one caesarian section procedures performed before and the time interval between previous caesarian section and subsequent pregnancy is shorter. Advanced maternal age is also associated with higher risk of the condition. Although uterine rupture rates among patients with scarred uterus are higher, it is also possible for complication to occur when the hysterotomy was never performed before. The uterine rupture often manifests with acute abdominal pain with or without hemodynamic changes and fetal heart rate changes, especially fetal bradycardia. Changes in pattern of uterine activity, cessation of contractions, vaginal bleeding and hematuria are other possible signs of uterine rupture. Management depends on hemodynamic stability of the patient and the extent of the rupture. In most cases the uterus can be surgically repaired, although when the rupture is extended and unrepairable, hysterectomy can be recommended. Management of complications includes stabling hemodynamics, suspecting and repairing rupture of bladder if needed.
Keywords: uterine rupture, caesarean section, risk factors, hysterectomy.