What are the early symptoms of uterine rupture and how to care for recovery

Uterine rupture is a serious threat to women's lives during pregnancy. Mothers should find and treat it early and observe their own conditions carefully. So what is uterine rupture? What are the causes of uterine rupture? What are the symptoms of uterine rupture? How to treat uterine rupture? How to prevent uterine rupture? How to care for uterine rupture? The following editor will introduce you in detail.

What is uterine rupture

Uterine rupture refers to a laceration of the uterine body or lower uterine segment during delivery or pregnancy. It is a serious obstetric complication that threatens the lives of mothers and children. Deaths are mainly caused by bleeding, infection, and shock. With the improvement of obstetric quality, the establishment and gradual improvement of urban and rural maternal and child health care networks, the incidence rate has dropped significantly. It is rarely seen in urban hospitals, but it occurs from time to time in remote rural areas. There are two types of uterine rupture:

(1) Complete uterine rupture: The entire uterine wall is torn, and part or all of the amniotic fluid, placenta, and fetus are squeezed into the abdominal cavity. When rupture occurs, the parturient suddenly feels a tearing pain in the abdomen, and then the contractions stop and the abdominal pain suddenly eases. Soon, as the amniotic fluid, fetus, and blood enter the abdominal cavity, persistent abdominal pain appears. The parturient has symptoms and signs of shock such as pale face, cold sweat, shallow breathing, weak pulse, and decreased blood pressure. There may be blood flowing out of the vagina, and the amount may be more or less. The fetal presenting part disappears during exposure and descent, and the dilated cervical os retracts. When the anterior wall of the uterus ruptures, the rupture may extend forward and cause bladder rupture. Abdominal examination shows tenderness and rebound pain in the whole abdomen. The fetal limbs can be clearly felt under the abdominal wall. The fetal heart sounds disappear, the outer shape of the uterus is unclear, and sometimes a shrunken uterine body can be felt on one side of the fetal body. If there is a lot of bleeding in the abdominal cavity, mobile dullness may be detected. Vaginal examination can reveal that the fetal presenting part rises, the cervical os shrinks, and sometimes the rupture can be felt in the uterine cavity.

(2) Incomplete rupture: The myometrium of the uterus is partially or completely torn, while the serosal layer remains intact. The uterine cavity and the abdominal cavity are blocked, and the fetus remains in the uterine cavity. If the tear is in the lower part of the uterine side wall, a hematoma may form between the two leaves of the broad ligament. If the uterine artery is torn, it may cause severe extraperitoneal bleeding and shock. Abdominal examination shows that the uterus still retains its original shape. After the rupture, there is obvious tenderness, and a gradually increasing hematoma can be felt on one side of the abdomen. The broad ligament hematoma can also extend upward to become a retroperitoneal hematoma. If the bleeding does not stop, the hematoma can penetrate the serosal layer, forming a complete uterine rupture.

What causes uterine rupture?

1. Obstructive dystocia: obvious pelvic stenosis, cephalopelvic disproportion, soft birth canal deformity, pelvic tumors and abnormal fetal position hinder the descent of the fetal presenting part and cause uterine rupture;

2. Uterine scar rupture: The cause of rupture is the mechanical traction of the pregnant uterus leading to rupture of the scar or damage to the endometrium at the uterine scar, placenta implantation, and placenta percreta leading to spontaneous rupture of the uterus.

3. Abuse of uterotonics: The main reasons include excessive dosage or too fast administration speed, immature cervix, malposition of the fetus, obstructive dystocia, and lack of careful observation of the labor process during medication.

4. Injury during vaginal delivery: Incomplete dilation of the cervix, forced forceps or gluteal traction leading to severe cervical lacerations extending to the lower uterine segment. Ignoring transverse internal version, abortion, partial artificial placental removal, etc., due to improper operation, can all cause uterine rupture.

5. Uterine malformation and uterine wall hypoplasia: The most common are bicornuate uterus or unicornuate uterus.

6. Uterine lesions: history of multiple curettages in multiparous women, history of infectious abortion, history of intrauterine infection, history of artificial placental removal, history of hydatidiform mole, etc.

What are the symptoms of uterine rupture?

Uterine rupture can occur in late pregnancy before labor, but most of them occur during labor when labor is difficult, manifested as prolonged labor, the fetal head or presenting part cannot enter the pelvis or is blocked at or above the plane of the ischial spine. Most uterine ruptures can be divided into two stages: threatened uterine rupture and uterine rupture. 1. Premature uterine rupture During labor, when the fetal presenting part is blocked from descending, strong contractions cause the lower uterine segment to gradually thin while the uterine body becomes thicker and shorter, forming a distinct annular depression between the two. This depression will gradually rise to the level of the umbilicus or above the umbilicus, which is called a pathological contraction ring. At this time, the lower segment is bulging, tenderness is obvious, and the round ligament of the uterus is extremely tense, which can be clearly touched and tenderness. The parturient complains of unbearable pain in the lower abdomen, irritability, calling, and rapid pulse and breathing. Because the fetal presenting part presses the bladder tightly and causes congestion, urination difficulties occur and hematuria is formed. Due to excessive contractions of the uterus, the blood supply to the fetus is blocked, and the fetal heart rate changes or cannot be heard clearly. If this condition is not resolved immediately, the uterus will soon rupture at and below the pathological contraction ring. 2. Uterine rupture can be divided into complete uterine rupture and incomplete uterine rupture according to the degree of rupture.

(1) Complete uterine rupture: refers to the rupture of the entire uterine wall, which allows the uterine cavity to communicate with the abdominal cavity. At the moment of complete uterine rupture, the parturient often feels severe tearing abdominal pain, which is then relieved by the disappearance of uterine contractions. However, as blood, amniotic fluid and the fetus enter the abdominal cavity, the parturient soon feels pain in the whole abdomen again, with a rapid and weak pulse, rapid breathing and a drop in blood pressure. During the examination, there is tenderness and rebound pain in the whole abdomen, the fetus can be clearly palpated under the abdominal wall, the uterus shrinks and is located to the side of the fetus, the fetal heart disappears, and there may be fresh blood flowing out of the vagina, which may be more or less. The fetal presenting part disappears during exposure or descent (the fetus enters the abdominal cavity), and the dilated cervix may retract. When the anterior uterine wall ruptures, the tear may extend forward and cause bladder rupture. If the uterine rupture has been confirmed, there is no need to examine the uterine rupture through the vagina. If the uterine rupture is caused by oxytocin injection, the parturient will feel strong uterine contractions and sudden severe pain after the injection, and the presenting part will rise and disappear immediately. The abdominal examination is as shown above. Uterine scar rupture may occur in late pregnancy, but more often during childbirth. At first, there is slight abdominal pain and tenderness at the uterine incision scar. At this time, the uterine scar may be ruptured, but the fetal membrane is not ruptured and the fetal heart rate is good. If a cesarean section is not performed immediately, the fetus may enter the abdominal cavity through the rupture, resulting in symptoms and signs similar to those of uterine rupture.

(2) Incomplete uterine rupture: refers to the complete or partial rupture of the uterine myometrium, the serosal layer has not been ruptured, the uterine cavity and the abdominal cavity are not connected, and the fetus and its appendages are still in the uterine cavity. Abdominal examination shows tenderness at the site of incomplete uterine rupture. If the rupture occurs between the two leaves of the broad ligament of the uterine side wall, a broad ligament hematoma may form. At this time, a gradually enlarging and tender mass can be felt on one side of the uterine body. Fetal heart sounds are often irregular.

How to treat uterine rupture

1. Threatened uterine rupture: Use sedatives to suppress uterine contractions and perform cesarean section as soon as possible.

2. Uterine rupture: While correcting shock and preventing infection, laparotomy should be performed in principle to ensure simplicity and speed in order to stop bleeding. Different surgical methods are determined based on the degree and location of uterine rupture, the time between the operation and the occurrence of rupture, and whether there is severe infection.

3. Conventional treatment

(1) General treatment: rescue shock with infusion, blood transfusion, oxygen inhalation, etc. and give large doses of antibiotics to prevent infection.

(2) Surgical treatment:

① Threatened uterine rupture: When threatened uterine rupture is found, drugs that inhibit uterine contractions should be given immediately, such as inhalation or if present, a cesarean section should be performed as soon as possible, and a live baby may be obtained.

②Surgical treatment of uterine rupture:

A. If the uterus ruptures within 12 hours, the edges of the rupture are neat, there is no obvious infection, and the patient needs to retain fertility, repairing and suturing the rupture may be considered.

B. If the rupture is large or the tear is uneven and there is a possibility of infection, consider subtotal hysterectomy.

C. If the uterine rupture is not only in the lower segment but also extends from the lower segment to the cervical os, consider performing a radical hysterectomy.

D. If the scar of the previous cesarean section is ruptured, including the uterine body or lower uterine segment, if the mother has a live baby, the rupture should be sutured and bilateral tubal ligation should be performed at the same time.

E. When there is a huge hematoma in the broad ligament, in order to avoid damaging the surrounding organs, the broad ligament must be opened, the ascending branch of the uterine artery and its accompanying vein must be freed, and the ureter and bladder must be pushed away from the tissue to be clamped to avoid damaging the ureter or bladder. If there is still active bleeding during the operation, the ipsilateral internal iliac artery can be ligated first to control the bleeding.

F. During laparotomy, in addition to paying attention to the site of uterine rupture, the bladder, ureter, cervix and vagina should be carefully examined. If damage is found, these organs should be repaired at the same time.

G. For some neglected cases with long labor and severe infection, the operation time should be shortened as much as possible to save the life of the parturient. The operation should be as simple as possible to stop bleeding quickly. Whether a total hysterectomy or subtotal hysterectomy or only rupture suture plus bilateral tubal ligation can be performed depends on the specific situation. Large doses of effective antibiotics should be used before and after the operation to prevent infection.

H. For patients with uterine rupture and shock, emergency treatment should be given on site as much as possible to avoid worsening shock and bleeding due to transportation. However, if transfer to another hospital is necessary due to local conditions, the patient should be transferred with massive infusion of fluids and blood to counteract shock and with the abdomen bandaged.

How to prevent uterine rupture

1. Strengthen the publicity and implementation of family planning to reduce the number of multiparous women;

2. Change the concept of childbirth, promote natural childbirth, and reduce the cesarean section rate;

3. Strengthen prenatal examinations and correct malposition of the fetus. Patients who are expected to have difficulty in delivery, or have a history of dystocia or cesarean section should be hospitalized for delivery early, and the progress of labor should be closely observed. The mode of delivery should be decided based on obstetric indications and the course of previous surgery.

4. Strictly follow the indications, usage and dosage of oxytocin, and have someone on guard;

5. For women with uterine scars or uterine malformations who are trying to give birth, the labor process should be closely observed and the indications for cesarean section should be relaxed;

6. Closely observe the labor process, especially for pregnant women with high presenting part or abnormal fetal position during trial labor;

7. Avoid highly damaging vaginal deliveries and operations such as mid- and high-position forceps, delivering before the cervix is ​​fully dilated, ignoring the shoulder presentation and performing internal version, and forcibly removing the placenta when it is implanted.

How to care for uterine rupture

1. Relieve pain, prevent uterine rupture, closely monitor uterine contractions, fetal heart rate and signs of uterine rupture, and report to the doctor immediately if any signs of uterine rupture are found. If intravenous infusion of oxytocin is used, it should be stopped immediately. Give oxygen, establish intravenous access, monitor blood pressure, pulse, and respiration. Give sedatives and drugs to inhibit uterine contractions as prescribed by the doctor, and make preparations for cesarean section.

2. Rescue shock and maintain vital signs. If uterine rupture has occurred, assist the doctor, execute the doctor's orders, and provide effective care.

① Rapidly establish intravenous access, replenish blood volume, and correct acidosis.

②Keep warm, inhale oxygen, and lie flat.

③ Make preoperative preparations as soon as possible.

④ Use large doses of antibiotics during and after surgery to prevent infection.

⑤ Closely observe vital signs and promptly assess blood loss to guide treatment and nursing plans.

3. Provide psychological support and psychological care, explain to the mother and her family the treatment plan for threatened uterine rupture and uterine rupture and the impact on the future. Show sympathy and understanding for the sadness and resentment expressed by the mother and her family. Help them get rid of their sadness as soon as possible and stabilize their emotions.