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An old cesarean scar may undergo dehiscence; with further labor the woman may experience abdominal pain and vaginal bleeding, though these signs are difficult to distinguish from normal labor. Often a deterioration of the fetal heart rate is a leading sign, but the cardinal sign of uterine rupture is loss of fetal station on manual vaginal exam.
In 2015 about 6.5 million cases of obstructed labour or uterine rupture occurred. [5] This resulted in 23,000 maternal deaths down from 29,000 deaths in 1990 (about 8% of all deaths related to pregnancy). [2] [6] [9] It is also one of the leading causes of stillbirth. [10] Most deaths due to this condition occur in the developing world. [1]
Caesarean sections need to be performed immediately if there are signs of fetal distress, uterine rupture, or cord prolapse. It is important that medical professionals are equipped and prepared in the case of an imperative C-section. There is a window of time by which Caesarean sections need to be executed if any warning signs present themselves.
Besides placenta previa and placental abruption, uterine rupture can occur, which is a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, but may occur with two conditions called vasa previa and velamentous umbilical cord insertion where the fetal blood vessels lie near the placental insertion site unprotected by Wharton's jelly of the cord. [11]
Uterine artery ligation, with or without ligation of the tubo-ovarian vessels. [1] [32] Ligation of the uterine and utero-ovarian arteries can decrease uterine bleeding by reducing the pressure of arterial blood flow in the uterus. It will not completely control the bleeding but may decrease blood loss while other interventions are being attempted.
The lower segment becomes stretched and thinner and, if neglected, may lead to uterine rupture. It is a major pathology behind obstructed labor. A circular groove encircling the uterus is formed between the active upper segment and the distended lower segment. Due to pronounced retraction, there is fetal jeopardy or even death.
Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy. [6] Placental abruption is the reason for about 15% of infant deaths around the time of birth. [2] The condition was described at least as early as 1664. [7]
Uterine rupture is when the muscular wall of the uterus tears during childbirth or, less commonly, during pregnancy. Nontubal ectopic pregnancy refers to an ectopic pregnancy that occurs in the ovary, cervix, or intra-abdominal cavity. Other causes of early pregnancy bleeding include the following: