Uterine Rupture/Inversion

Question 1

what is a uterine rupture?

Answer 1

a disruption of the uterine muscle extending to and involving the uterine serosa or disruption of the uterine muscle with extension to the bladder or broad ligament

Question 2

what is uterine dehiscence?

Answer 2

defined as disruption of the uterine muscle with intact uterine serosa

Question 3

What are possible risk factors of uterine rupture?

Answer 3

• high parity
• multiple pregnancy
• previous uterine trauma
• previous uterine surgery
• induction and/or augmentation of labour
• high or mid cavity forceps
• obstructed labour
• direct trauma
• extension of a cervical laceration
• internal manipulation to correct unstable lie or malpresentation

Question 4

what are complications from uterine rupture?

Answer 4

• maternal haemorrhage (concealed or revealed)
• infection
• damage to other pelvic structures
• hysterectomy
• fetal compromise and possible demise
• maternal death

Question 5

signs & symptoms of uterine rupture?

Answer 5

1. cessation of previously effective contractions
2. tonic/hypertonic contractions
3. pain unrelated to contractions
4. pain over the uterine scar
5. shoulder tip pain
6. antepartum haemorrhage (revealed or concealed)
7. postpartum haemorrhage
8. increased respiration rate, raised heart rate
9. haematuria
10. fetus palpated in maternal abdomen
11. loss of station of the presenting part
12. abnormal fetal heart rate pattern no FHR

Question 6

When does a uterine inversion occur?

Answer 6

when the uterus inverts, the fundus descends abnormally through the genital tract, turning itself inside out

Question 7

what is a 1st degree uterine inversion?

Answer 7

the fundus inverts/dimples and reaches the internal os

Question 8

what is a 2nd degree uterine inversion?

Answer 8

the body of the uterus is inverted and protrudes through the cervix into the vagina

Question 9

what is a 3rd degree uterine inversion?

Answer 9

the uterus is completely inverted and appears outside the vulva

Question 10

what are possible causes of uterine inversion?

Answer 10

• abnormally adherent placenta
• uterine abnormalities
• precipitate labour and birth
• multiparty
• prolonged labour
• short umbilical cord
• performing controlled cord traction prior to placental separation
• manual removal of placenta
• inappropriate fundal pressure
• VBAC
• fetal macrosomia
• connective tissue disorders e.g Marfan syndrome

Question 11

what are complications of uterine rupture?

Answer 11

• maternal shock and collapse
• postpartum haemorrhage
• pain
• hysterectomy
• endometritis
• damage to intestines and/or other pelvic anatomy

Question 12

signs and symptoms of uterine rupture?

Answer 12

• lower abdominal and or back pain
• excessive blood loss
• funds feels dimpled or not in its proper position on abdominal palpation or vaginal examination
• uterine protrusion at the Introitus
• shock disproportional to observed blood loss (this is dye to parasympathetic effect of traction on the ligament)

Question 13

What steps should be taken when a uterine inversion is diagnosed?

Answer 13

1. call for help
2. lie patient flat
3. high flow oxygen
4. observations
5. 2 large bore cannulas
6. blood samples - cross match 4 units
7. commence iv fluids
8. if maternal shock - manage accordingly
9. replacing of the uterus