A uterine rupture is a partial or complete tear in the wall of the uterus, most commonly occurring during childbirth or during labour. With a frequency of about 1:1500 births, a uterine rupture is a relatively rare, although very life-threatening complication due to the high mortality rate.
What is a uterine rupture?
A uterine rupture is a tear or tearing of the uterine wall, usually during the birth process. In principle, a complete tear involving the serosa (smooth lining of the peritoneal cavity) and dehiscence (separation) of all layers and an incomplete or extraperitoneal rupture, which only affects the myometrium (smooth muscle layer of the uterine wall) and does not lead to bleeding into the abdominal cavity, differentiated. For kaposi’s sarcoma 101, please visit photionary.com.
As a rule, the rupture is localized at the junction between the body and the cervix (isthmus uteri), more rarely at a point with a weak wall (“silent rupture of the lower rupture”). The main symptoms of a uterine rupture are abrupt abdominal pain with pronounced tenderness and a sudden cessation of contractions.
As a result of the blood loss, signs of shock appear promptly ( hypotension, tachycardia, pale and cold-sweaty skin, worsening clouding of consciousness). In addition, after a uterine rupture, the unborn child cannot move and the heart sounds are bradycardic (slowed down) or non-existent.
Causes
In principle, a uterine rupture is induced by a discrepancy between the load-bearing capacity of the uterine wall and the actual load.
Depending on the underlying cause, a distinction is made between different types of rupture. Scar rupture can occur as a result of previous damage to the uterus, such as enucleation of the uterine fibroid (fibroid nucleation), placental ablation, metroplasty or caesarean section. Previous surgical interventions on the uterus are the most common cause of a rupture.
A narrow pelvis and fetal position anomalies (transverse position, mentoposterior face position of the child, arm prolapse, macrosomia) can cause a hyperextension rupture. On the other hand, a spontaneous rupture can be caused by endometriosis or a hemangioma. Blunt or sharp abdominal trauma (e.g. as a result of forceps extraction or a traffic accident) can also lead to a violent or traumatic uterine rupture.
Symptoms, Ailments & Signs
A uterine rupture announces itself with warning signals. Affected women are extremely concerned during pregnancy. You complain of severe pain in the uterus. In particular, the so-called labor storm indicates complications during birth. The frequency of contractions then increases steadily in the run-up to birth.
If the uterus tears, pain is felt immediately. These extend beyond the uterus to the entire abdomen. The expectant mothers often describe the feeling of being torn from within. As a result of the injury, vaginal bleeding occurs, which in turn can trigger shock. Blood pressure plummets and heart rate increases.
Cold sweat breaks out on the forehead and the skin takes on a strangely pale color in seconds. In this situation, labor stops. The women lose control of their birth and no longer feel the movements of their child. A uterine rupture affects about 1 in 1,500 expectant mothers. Doctors distinguish between a complete and an incomplete tear. If it occurs, there will still be blood in the mother’s urine for a short time after birth.
In rare cases, a uterine rupture can initially proceed without any obvious symptoms. One affected person described it to us as follows:
” Even a complete rupture of the uterus can be asymptomatic, meaning there is no vaginal bleeding. After heavy labor, there can be a lull where nothing happens before the rupture occurs with severe pain. Many doctors, paramedics, and midwives don’t know this. I have I lost my child as a result. My rupture was complete. I had no vaginal bleeding or shock, just freaking intense pain and vomiting. There was no suspicion. ”
Diagnosis & History
A uterine rupture is usually diagnosed on the basis of the clinical symptoms. In addition, any unclear post- and intrapartum state of shock should be interpreted as a clear indication of a uterine rupture.
In addition, an impending rupture of the uterus can be announced by certain symptoms. Hyperactive, painful contractions up to and including stormy labor (pathologically increased labor activity), pressure pain in the lower uterine segment on external palpation, lifting of the Bandl ring above the navel, and restlessness and anxiety in the affected pregnant woman as a result of the pronounced pain indicate an impending uterine rupture.
However, a partial rupture of the uterus can also be asymptomatic in many cases. With a mortality rate of 10 percent for the affected mothers and 50 percent for the unborn fetus, a uterine rupture is one of the most serious and life-threatening obstetric complications and should always be treated immediately by emergency medicine.
Complications
Depending on the size of the tear, a uterine rupture can have serious complications. Most of the time, a ruptured uterus causes heavy vaginal bleeding, which can lead to anemia. Severe abdominal pain and sweating are among the possible accompanying symptoms.
A pronounced rupture can lead to circulatory shock, combined with tachycardia, drop in blood pressure and other symptoms. Life-threatening complications occur if the rupture of the uterus is not treated immediately in intensive care medicine. Then there is a risk that the affected woman will bleed to death or suffer a heart attack.
A circulatory collapse can also be life-threatening. In a child, a ruptured uterus causes the heart rate to slow down. In many cases, the child dies of heart failure or severe circulatory shock. Other, mostly serious complications cannot be ruled out in the case of a pronounced ruptured uterus.
When treating such a serious rupture, the risks stem from the prescribed anti-contract drugs, which are associated with various side effects and interactions. Any removal of the uterus can cause injury and infection. After the procedure, the fertility of the affected woman is limited and further physical and psychological complications arise. The loss of a child has far-reaching psychological consequences for those affected.
When should you go to the doctor?
A doctor must always be contacted in the event of a uterine rupture. Immediate treatment is usually necessary to prevent further complications or symptoms, which in the worst case can lead to the death of the mother or child. Therefore, a doctor must be contacted at the first symptoms or signs of this complaint. A doctor should be contacted for this complaint if the frequency of contractions increases significantly before birth. In most cases, those affected suffer from very severe pain as a result of the uterine rupture.
There is also bleeding in the vaginal area, which is also associated with severe abdominal pain. Low blood pressure can also indicate a uterine rupture and must be examined by a doctor. Bloody urine can also indicate this complaint. In most cases, a uterine rupture is treated by a doctor immediately after birth. It cannot generally be predicted whether this will lead to further complications or to a reduced life expectancy for the mother or the child.
Treatment & Therapy
Immediate emergency medical measures are indicated in the event of an impending rupture of the uterus as well as one that has already occurred. To inhibit labor activity, so-called tocolytics, which minimize the contraction activity of the uterus, are infused intravenously as part of an acute tocolysis.
The standard first-line treatment is an intravenous bolus injection of 0.025 mg fenoterol (a beta-2 sympathomimetic), which can be repeated once without risking circulatory decompensation in the unborn child. In addition, shock prophylactic measures are required.
If there is a suspicion that a rupture is imminent or has already taken place, immediate referral to a clinic is indicated, where usually a laparatomy (surgical opening of the abdominal wall) in the case of a laborless uterus or, if labor is present, a caesarean section (section birth, caesarean section ) is performed as soon as possible ) with subsequent reconstruction of the uterus.
If the bleeding cannot be stopped or if it is particularly severe, a total laparoscopic hysterectomy or uterine extirpation (removal of the uterus) may be necessary. If a rupture of the uterus is suspected during the delivery process, a caesarean section is also carried out as an emergency. At the same time, hypovolemic shock (reduced circulating blood flow) as a result of blood loss in the event of a uterine rupture should always be treated using volume and blood doses.
Prevention
A uterine rupture cannot be prevented in every case. In the case of surgical interventions on the uterus that have already taken place, the risk of a rupture, especially scar ruptures, is slightly increased and the course of the pregnancy should be monitored and monitored accordingly due to the high mortality associated with uterine ruptures.
Aftercare
As part of the medical follow-up care in the event of a ruptured uterus, the affected woman and, if applicable, the unborn child must be examined. It is also relevant whether organs adjacent to the uterus are also affected. The medical follow-up after a uterine rupture depends on how well the tear could be controlled surgically and what damage the bleeding caused to the mother (and child).
In the case of a woman affected by a ruptured uterus, the focus is on stabilizing the body aftercare. It is not uncommon for a uterine tear to be accompanied by shock-like symptoms, which makes observation and a follow-up examination necessary.
Furthermore, wound care and, if necessary, antihemorrhagic medication are indicated as follow-up care. If a cesarean section was performed due to the rupture, the child must be examined in detail. A uterine rupture directly endangers the child in the womb and, among other things, causes the heart rate to drop. Accordingly, any consequential damage must be determined.
If a hysterectomy was performed to treat the uterine rupture, the follow-up care for the affected person consists not only of check-ups but also, if necessary, of psychological support. In the case of a covered uterine tear that does not lead to bleeding into the abdominal cavity, medical follow-up care is often not urgently required. An observation of the tissue, especially during a possible further pregnancy, is sufficient.
You can do that yourself
If this birth complication was announced in advance or if there were risk factors, the expectant mothers were closely monitored by their doctors or in the clinics. If, on the other hand, expectant mothers are surprised by the symptoms of a uterine rupture shortly before the delivery, they have to hurry. If the patient is already in the clinic, she needs intensive care. If she is not in the clinic yet, she must be transported there quickly, as there is a risk of death for both the mother and the unborn child.
The rupture of the uterus is treated surgically. Regardless of how the situation ended, it is very stressful for the affected patient. Either because she and her unborn child were in mortal danger, or because she even lost her child in the process and may not be able to become a mother in the future either. In order to cope with this situation, psychotherapeutic follow-up treatment is advisable. Joining a support group can also be helpful. For example, the website Schmetterlingskinder.de offers immediate help in the event of the loss of a child. The websites Elternforen.com or Familienplanung.de also provide helpful information on the term uterine rupture.
The bleeding that occurred when the uterus ruptured may also have caused iron deficiency. The patient should therefore have her iron status monitored and, if necessary, take iron supplements regularly.
