Uterine rupture is a rare but nevertheless potentially catastrophic complication that can occur in pregnancy.
The incidence rate in pregnancy is at 0.05% 6.
Uterine rupture is usually an acute presentation with haemodynamic instability and abdominal discomfort.
The most common cause (>90%) of uterine rupture is an old Caesarean section (CS) scar. Uterine rupture may be limited to dehiscence of the ends of the cesarean scar with an intact overlying serosal layer. A full-thickness uterine rupture with direct communication of the uterine and peritoneal cavities resulting in massive haemoperitoneum and carries high fetal and maternal morbidity and mortality. Classic scars are more likely to rupture before labour, whereas lower uterine segment scars (LUSCS) tend to rupture after labour.
In general uterine ruptures tend to favour the anterior lower uterine segment, especially when associated with pregnancy.
Reported sonographic signs of uterine rupture include:
- identification of the protruding portion of the amniotic sac
- endometrial or myometrial defect
- extra-uterine haematoma
- haemoperitoneum or free fluid
Multiplanar MR imaging offers a comprehensive assessment of the uterine wall and the peritoneal cavity.
Treatment and prognosis
Uterine rupture is most often an obstetric emergency (especially if associated with pregnancy). Hysterectomy is often required as part of management.
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- 6. Eurorad teaching files : Case 9132