Dx of Uterine rupture

Obstetric Anesthesia

Definition: full-thickness separation of the uterine wall and the overlying serosa

Incidence of ~ 1% during VBAC , with a maternal/fetal morbidity rate of 10% or higher. Induction of labor increaes the risk 10-fold. ACOG therefore recommends that an anesthesiologist be immediately available for any VBAC.

Fetal bradycardia is the most sensitive sign. Other signs include hypotension (may occur late), abdominal pain, expulsion or protrusion of the fetus, placenta, or both into the abdominal cavity, malfunction of uterine pressure monitoring equipment / lower pressure readings, loss of uterine contractility, recession of the presenting fetal part.

Ultrasound may be helpful in diagnosis

Risk factors include previous C/S (esp w/ classical), myomectomy, multiple gestation, hydaditiform mole/choriocarcinoma

Uterine Rupture

  • Fetal bradycardia most sensitive sign
  • Other signs: abdominal pain, lower baseline uterine pressure, hypotension, shock, recession of presenting part
  • Incidence: ~ 1% of VBAC, less common in spontaneous labor, 10-fold increase with induction
  • Risk factors: previous C/S (esp w/ classical), myomectomy, multiple gestation, hydaditiform mole/choriocarcinoma

EFFECTS ON FETUS

  • Hypoxia/anoxia
  • Acidosis
  • Death

EFFECTS ON MOM

  • Severe blood loss
  • Hysterectomy
  • Bladder injury
  • Cystotomy
  • Death