Early identification of uterine rupture and immediate intervention is key to reducing morbidity and mortality related to uterine rupture. The following are signs/symptoms that may suggest uterine rupture:
Maternal signs/symptoms
- Unstable vitals – Hypotension, tachycardia, decreased LOC
- Pain– intense abdominal pain that persists between contractions (this may be masked by neuraxial analgesia), abdominal peritonitis like rigidity, rebound tenderness
- Bleeding- vaginal bleeding may or may not be present, depending on where the rupture has occurred
- Change in abdominal shape- there may be change in the abdominal girth, shape
- Palpation of fetal part in abdomen
- Inability to palpate fundus (if fundal rupture has occurred)
- Cessation of uterine contractions
- Free fluid in the abdomen on bedside ultrasound
Fetal signs
- Fetal heart rate changes- commonly bradycardia with no recovery due to loss of blood supply is the most common objective sign, can also present with variable or late decelerations
- Loss of station- if rupture has occurred, the fetus may have passed through the rupture into the abdominal cavity and present as a loss of station.
Uterine rupture can also occur post delivery. It is important to do a bimanual exam after delivery to ensure the uterus is intact, particularly if there is significant bleeding post delivery.