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Transeverse uterine rupture. Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth. [3] Symptoms, while classically including increased pain, vaginal bleeding, or a change in contractions, are not always present. [1] [2] Disability or death of the mother or baby may result. [1] [3]
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]
A caesarean section leaves a scar in the wall of the uterus which is considered weaker than the normal uterine wall. A VBAC carries a risk of uterine rupture of 22–74/10,000. Slightly lower risk of uterine rupture in women undergoing ERCS (i.e. a section before the onset of labour). [1]
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]
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]
In an incomplete rupture, the peritoneum is still intact. With a complete rupture, the contents of the uterus may spill into the peritoneal cavity or the broad ligament. A uterine rupture is a life-threatening event for both mother and baby as it typically results in severe hemorrhage and can cause perinatal asphyxia.
Sealing membranes after rupture: Infection is the major risk associated with PROM and PPROM. [25] By closing the ruptured membranes, it is hoped that there would be a decrease in infection, as well as encouraging the re-accumulation of amniotic fluid in the uterus to protect the fetus and allow for further lung development.
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.