Rupture of an unscarred uterus?

LookingAhead · Nov 28, 2011

Others should chime in here, but according to the literature this is seriously rare.

Some quick info below (http://emedicine.medscape.com/article/275854-overview#aw2aab6b3):

Rupture of the Unscarred Uterus

The normal, unscarred uterus is least susceptible to rupture. Grand multiparity, neglected labor, malpresentation, breech extraction, and uterine instrumentation are all predisposing factors for uterine rupture. A 10-year Irish study by Gardeil et al showed that the overall rate of unscarred uterine rupture during pregnancy was 1 per 30,764 deliveries (0.0033%). No cases of uterine rupture occurred among 21,998 primigravidas, and only 2 (0.0051%) occurred among 39,529 multigravidas with no uterine scar.[1]

A meta-analysis of 8 large, modern (1975-2009) studies from industrialized countries revealed 174 uterine ruptures among 1,467,534 deliveries. This finding suggested that the modern rate of unscarred uterine rupture during pregnancy is 0.012% (1 of 8,434). This rate of spontaneous uterine rupture has not changed appreciably over the last 40 years, and most of these events occur at term and during labor. An 8-fold increased incidence of uterine rupture of 0.11% (1 in 920) has been noted in developing countries. This increased incidence of uterine rupture has been attributed to a higher-than-average incidence of neglected and obstructed labor due to inadequate access to medical care. When one assesses the risk of uterine rupture, this baseline rate of pregnancy-related uterine rupture is a benchmark that must be used as a point of reference.

1. Gardeil F, Daly S, Turner MJ. Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol. Aug 1994;56(2):107-10.

Elvish, BSN, DNP, RN, NP · Nov 28, 2011

It is pretty rare. I have seen it twice since I've been in this field, and neither had had a previous c/s.

Esme12, ASN, BSN, RN · Nov 28, 2011

Abstract

OBJECTIVES:

To determine the etiologic factors explaining the appearance of uterine rupture on unscarred gravid uterus and to value the maternal and foetal prognosis of this complication.

PATIENTS AND METHODS:

The authors report a study of 28 cases of uterine rupture on unscarred gravid uterus, recorded between January 1989 and December 1997, at the department of obstetrics and gynecology, Farhat Hached University Hospital, Sousse, Tunisia.

RESULTS:

Out of the 72283 deliveries during the study period, there were 28 ruptured uteri of unscarred uterus giving a hospital incidence of one in 2581 deliveries. Multiparity, neglected labour dystocia and obstetric procedure were the common etiologic factors accused in the occurring of this complication. To be added to these factors: the low socio-economic status of the patients and lack of antenatal care. The surgical management was conservative (repair) in 19 cases (67.9%); hysterectomy was indicated in nine cases (32.1%). Maternal and fetal morbidity and mortality were important: we deplore two maternal deaths (7.1%) and seven fetal deaths (24.1%).

DISCUSSION AND CONCLUSION:

Uterine rupture on unscarred uterus is a relatively rare complication of the pregnancy. However, its incidence remains high in developing countries. Its occurrence is significantly associated with grandmultiparity, lack of antenatal care and low socio-economic status of the patients.

http://www.ncbi.nlm.nih.gov/pubmed/14499715

http://www.uptodate.com/contents/rupture-of-the-unscarred-uterus

Your patients biggest risk was her multiparity.......a rare complication but it does occur. I am glad mom and baby survived.

Nicky30, BSN, RN · Nov 29, 2011

I was not working but there have been two in our region.

The first was a primip and went to section for obstructed labour. When the first incision was made into the uterus it ruptured. Babe delivered ultra quick and was 11lb 2oz. Uterus was repaired and mum went on to have a second pregnancy delivered by LSCS at 38w.

The second one was a multi, 5th bubs but first with a new partner and it was too late :crying2: . She required an emergency hysterectomy.

bagladyrn, RN · Nov 29, 2011

I have personally seen one 23 yrs. of doing OB. It was in a primip with no known risk factors. The lower uterine segment ruptured right as she delivered. The staff in the room at the moment were myself and a midwife. Fortunately being in a reservation hospital all the docs and OR staff lived on the compound around the hospital and were there within minutes.

Patient ended up with an immediate hysterectomy and received multiple units of blood.

cosmicmama, BSN, RN · Nov 29, 2011

Very rare...but just wondering, were you using Cytotec? The only ones I've heard of in an unscarred uterus involved cytotec.

heatheryk · Nov 29, 2011

Cytotec use was the first thing that came to my mind as well. Although any induction puts a woman at increased risk for rupture.

babyktchr, BSN, RN · Nov 29, 2011

it is rare, but have seen it twice....both were multips with very thin lower uterine segments. scary stuff

2curlygirls · Nov 30, 2011

Just to clarify...I am NICU, we got the baby. Yes, they did use Cytotec from what I read in the delivery summary. Thanks for all your replies!

rbytsdy · Dec 2, 2011

It's very rare. I know we usually think of UR as something in VBAC attempts but the population of women VBACing is pretty low so I've found that most nurses who witness a UR seem to witness them in an unscarred uterus.

Unfortunately, cytotec has been known to cause ruptures in women without a previous uterine surgery. It would be interesting to find out the dose used on this woman (and how often).

Cytotec was used on many VBAC patients in the 90s which caused a lot of UR and therefore made VBAC a "bad" choice. Instead of blaming the cyctotec, the VBAC attempt was blamed.

NurseNora, BSN, RN · Dec 10, 2011

In 43 years, I can think of only one spontaneous rupture in a nullip not on Pit and in early labor. She was just starting to think about going to the hospital to see if she was in labor when she had sudden terrible pain. When she got to the hospital, she was found to be ruptured. The baby did not survive.

With her second baby, she had a repeat of the same thing--sudden horrible pain out of nowhere. Her husband called the medical helicopter service to come to their home and when told that they had to be sent by a doctor, he said this happened with the last pregnancy and the baby died and if he lost his wife or baby, he'd own the company. They landed in the street outside his front door and got his wife to the hospital in time to get a good baby.

All the other ruptures I've seen were obstructed labor (but not in 30+ years), or on Pit or had previous uterine surgery.