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Uterine Rupture

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Shoulder dystocia
Cord prolaspe
Uterine rupture
Placental abruption

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The incidence of uterine rupture is 0.05% of all pregnancies (Reference1), occurring between 1 in 140 to 300 of women with a pre-existing scar (Reference2). The risk increases with the number of caesarean sections; two previous sections carry a 3 to 5 fold risk over one previous section (Reference3,Reference4). The perinatal mortality is ten times that of the maternal mortality (Reference1).

CESDI established a focus group to report on the 42 cases in 1994-5 which resulted in an intrapartum death. Although 93% of these cases had impending warning signs, 57% had the diagnosis made only at the time of laparotomy. 75% of the cases were deemed to have grade 3 suboptimal care (significantly more than the other deaths in the enquiries).

CESDI (5th Annual Report) - Recommendations

Women with a uterine scar require:

  • Antenatal management including plans for delivery and induction involving a documented discussion with anexperienced obstetrician (ideally a consultant but at least SPR4 or higher).
  • Attentive intrapartum fetal and maternal surveillance in a setting where the baby can be delivered within 30 minutes.
  • Involvement of an experienced obstetrician in intrapartum decisions.
  • No more than one dose of prostaglandin unless great vigilance is exercised.
  • Information about relevant symptoms to be reported to those caring for them in labour.

Hospital units need to provide:

  • Local guidelines regarding the setting and standards of labour.
  • Local guidelines regarding the setting and standards of intrapartum fetal and maternal surveillance in women with uterine scar.
  • Whenever uterine rupture occurs it should be the subject of a departmental case review.

Training issues:

  • All involved in intrapartum care of women must be aware of the factors that may lead to uterine rupture. In particular, they must recognize that women with a uterine scar are 'high risk' and should be managed appropriately.
  • All involved in intrapartum care of women should undergo training in the use and interpretation of CTGs.

According to representatives of units in the West Midlands who attended this Forum, 44% of maternity units do not have fire drills on their labour suite on a regular basis.

Suggested management of uterine rupture
  • Stop oxytocinon
  • Call key personnel, haematologist, porter
  • Bloods, IV access & fluids (16 gauge venflon)
  • Continuous monitoring
  • Rapid delivery


1. Lynch JC. Uterine rupture and scar dehiscence. A five year survey. Anaesth Intens Care 1996;24:699-704, Abstract
2. CESDI 5th Annual Report published by the Maternal and Child Health Research Consortium in May 1998.
3. Miller D. Vaginal birth after cesarian: a 10 year experience. Obstet Gynecol 1994;84:255-8, Abstract
4. Caughey AB. Rate of uterine rupture during a trial of labor in women with one or two prior cesarian sections. Am J Obstet Gynecol 1999;181:872-6, Abstract

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