Uterine rupture and scar dehiscence

She is 6 cm, has one previous caesarean, and the syntocinon has been up for two hours. She has been comfortable on the epidural all night and now she says her tummy hurts between the contractions. Two minutes later the heart rate falls to 70 and stays there.^[4][15]

Do not top up the epidural. Do not order an ultrasound. Turn off the oxytocin, call the theatre and say the word "rupture" out loud, because in this scenario the diagnosis is made in the abdomen and nowhere else.^[1][8]

Overview and definition

• Complete (true) rupture: full-thickness separation of the uterine wall including the serosa, so the cavity communicates with the peritoneum. Fetal parts, cord or placenta may extrude. This is the emergency.^[1][9]
• Scar dehiscence (incomplete rupture, uterine window): the myometrium separates but the serosa or visceral peritoneum stays intact. Usually no bleeding, no fetal extrusion, and often found incidentally at repeat caesarean.^[1][9]

^{[1] [9] [15]}

The distinction is not academic. In the Dutch prospective national study, no adverse outcomes occurred among women with incomplete rupture, while complete rupture with adverse outcome ran at 0.9 per 10 000 births. In the Norwegian prelabour series, all 45 partial ruptures — 39 of them in lower-segment scars — produced no perinatal death and no hysterectomy.^[9][15]

References20ShowHide

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