Rupture of the uterus is a violation of the integrity of its walls. This is the most severe complication of pregnancy and childbirth.
It can be spontaneous, arising without external influence, and violent – under the influence of outside interference; according to the degree of damage – complete, capturing all the membranes of the uterine wall, and incomplete, when the rupture captures the endometrium and myometrium, while the perimetry remains intact.
Uterine ruptures appear with a spatial discrepancy between the presenting part of the fetus and the pelvis (narrow pelvis, transverse position of the fetus), extensor and asynclitic insertions of the head (large fetus, cicatricial narrowing of the soft tissues of the birth canal, small pelvic tumors that prevent natural delivery). Uterine ruptures are also observed with pathological changes in its wall due to inflammatory and dystrophic processes, as well as along the scar after a cesarean section or an operation to remove fibroma nodes.
The onset of uterine rupture is characterized by symptoms of a threatening rupture with the addition of signs indicating a tear of the uterine wall: the appearance of bloody discharge from the vagina, an admixture of blood in the urine, asphyxia of the fetus.
Completed rupture of the uterus is accompanied by a typical clinical picture and traditionally does not cause difficulties in diagnosis. At the moment of rupture, the woman in labor feels severe pain in the abdomen, labor activity stops, signs of shock are detected. The fetus quickly dies in utero, flatulence, Shchetkin-Blumberg symptom are detected, blood is released from the vagina.
When the fetus enters the abdominal cavity, the abdomen acquires an irregular shape, small parts of the fetus are clearly palpated through the anterior abdominal wall. Sometimes the diagnosis of uterine rupture is made late – after the end of childbirth or during the first days in the postpartum period, which threatens the development of diffuse peritonitis and sepsis. In this regard, a uterine rupture should be considered in cases where the puerperal suddenly has external bleeding after delivery and discharge afterward with a well-contracted uterus.
Suspicion of uterine rupture should arise when there is a delay in the aftermath in the uterus and the failure of its removal according to the Krede-Lazarevich method, as a result of difficult obstetric operations (external-internal rotation, fruit-destroying operations). In these cases, manual examination of the uterus reveals a rupture.
With a threatening and incipient uterine rupture, it will be necessary to urgently stop labor with the help of deep ether anesthesia (anesthesia should begin immediately). A woman in labor with a threatening and incipient uterine rupture is not transportable. Delivery is carried out on the spot. The choice of an operative method of delivery depends on the obstetric situation (caesarean section, fruit-destroying operation).
A completed uterine rupture requires immediate abdominal surgery without prior removal of the fetus. At the same time, measures are being taken to combat shock and collapse. The volume of surgical intervention depends on the prescription of the rupture, signs of the presence of infection, the condition of the torn uterine tissues, the location of the rupture (suturing of the uterus, supravaginal amputation of the uterus, extirpation of the uterus).