Uterine Rupture
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Direct answer
Uterine rupture is tearing of the uterine wall — in modern Indian practice most often through a previous caesarean scar, and in the unscarred uterus from obstructed labour, injudicious oxytocin or grand multiparity. The classic picture combines severe abdominal pain, cessation of contractions, loss of the fetal heart, superficially palpable fetal parts, recession of the presenting part, vaginal bleeding and hypovolaemic shock; rupture of a lower-segment scar, however, may announce itself only as fetal bradycardia or a rising pulse. Management is immediate laparotomy with aggressive resuscitation and blood, then repair of the uterus or hysterectomy depending on the tear, the woman's condition and her parity. Rupture differs from dehiscence, a silent, contained separation of a scar.
What you must remember
- Scarred-uterus causes: previous caesarean (commonest today), myomectomy or perforation repair; classical scars rupture earlier and harder than lower-segment scars.
- Unscarred-uterus causes: obstructed labour, injudicious oxytocin or prostaglandins, grand multiparity, external cephalic version, destructive procedures and neglected transverse lie.
- Pre-rupture warnings: a rising Bandl retraction ring, tender tense uterus, fetal tachycardia progressing to bradycardia, maternal tachycardia and scar tenderness.
- Established rupture: tearing pain, contractions cease, fetal parts palpable superficially, fetal heart absent, presenting part recedes, shock disproportionate to visible bleeding, sometimes haematuria.
- Complete rupture involves all layers including serosa; incomplete rupture (dehiscence) leaves serosa intact and is often an incidental finding.
- Management: two wide-bore cannulae, crossmatched blood, immediate laparotomy — repair small clean lower-segment tears; subtotal or total hysterectomy for extensive, ragged or infected tears in unstable women.
- Prevention: careful selection for trial of labour after caesarean, partograph vigilance, no oxytocin in obstructed labour, and family planning for grand multiparae.
Common confusion
Examiners contrast rupture with both dehiscence and abruption: dehiscence is silent and contained, rupture is catastrophic with absent fetal heart and superficial fetal parts; abruption keeps the fetus inside a tense board-like uterus with dark bleeding and usually a detectable — if distressed — fetal heart. The second favourite is the earliest sign in a labouring scar patient — fetal bradycardia, not pain, frequently comes first.
Exam-focused takeaway
FMGE frames rupture as cause and response: a grand multipara with prolonged labour on oxytocin, or a previous caesarean with a rising pulse and bradycardia, both answered by immediate laparotomy. Learn the unscarred cause list (obstructed labour first), Bandl ring as the pre-rupture sign, and the repair-versus-hysterectomy logic. The single most important step — emergency laparotomy with resuscitation — is the recurring one-liner.
Frequently asked questions
What is the commonest cause of uterine rupture today?
Rupture of a previous caesarean scar in labour; in unscarred uteri, obstructed labour with injudicious oxytocin in a grand multipara is the classical cause.
How does rupture differ from dehiscence?
Rupture is a complete tear with fetal extrusion, bleeding and shock; dehiscence is a silent separation of an old scar with serosa intact, usually found incidentally.
What are the early signs of scar rupture in labour?
Fetal heart abnormalities (bradycardia or late decelerations), scar tenderness, maternal tachycardia, loss of station of the head and cessation of good contractions.
What is Bandl ring?
A pathological retraction ring between the thinned lower and thickened upper segment in obstructed labour, warning of impending rupture.
How is uterine rupture managed?
Immediate resuscitation with blood and fluids plus emergency laparotomy to deliver the baby, then repair where feasible or hysterectomy for extensive ragged tears in an unstable woman.
Can the uterus be saved after rupture?
Yes — small, clean lower-segment ruptures in a stable woman desiring more children can be repaired, accepting a high recurrence risk that mandates elective caesarean next time.