Why does the uterus rupture during childbirth?24.05.2022
Rupture of the uterus (hysterorhexis) is a rare complication of labor, which is one of the most life-threatening for mother and child. Recognizing this condition in time and taking the necessary measures is the only way to avoid severe and sometimes tragic consequences.
Causes of uterine rupture during childbirth
According to statistics, hysterorhexis occurs in only 0.1-0.5% of women in labor, which makes this complication one of the rarest. The same statistics states that out of the total number of injuries of the birth canal, uterine ruptures occur predominantly in women who have undergone a caesarean section or other operations on the uterus, which left a scar behind.
Uterine rupture is a medical emergency requiring emergency care
Connective tissue is unable to stretch and contract in the same way as muscle fibers. Because of this, during contractions, excessive tension and a gap along the scar occur in it.
Less common causes of this complication include the following:
- Multiple pregnancy and polyhydramnios , in which there is an excessive stretching of the walls of the uterus and the elasticity of the muscles of the organ is significantly reduced.
- Anomalies in the development and position of the fetus that were not diagnosed in a timely manner. Labor contractions become excessive due to the fact that the fetus is not pushed into the birth canal.
- Anomalies in the structure of the pelvis in a pregnant woman or neoplasms of the soft tissues of the birth canal. This is the reason for the mechanical obstruction to the normal progress of the fetus.
- Inappropriate medical manipulations or their incorrect conduct (manual reversal of the fetus, the use of drugs that increase the tone of the uterus, as a result of which an organ rupture develops).
In most cases, the threat of hysterorhexis is diagnosed during pregnancy, and the obstetrician-gynecologist forms a program of obstetric care, taking into account all the identified circumstances. But sometimes the problem remains unidentified until the moment when the gap has already occurred. In such cases, it is important to pay attention to the symptoms as early as possible and provide the necessary assistance to the woman in labor.
Symptoms of uterine rupture
Signs of hysterorhexis vary depending on the degree of damage to the organ. In this regard, the following classification has been adopted:
- Threatening condition. At the same time, the tissues of the organ still retain their integrity, but are overly stretched and strained, which creates a threat of hysterorhexis. Among the main symptoms of this condition are a sharp pain in the lower abdomen, swelling of the external genital organs, lack of urge to urinate, and an increase in body temperature up to 37.5-38.0 ° C. Even the initial degree of injury becomes dangerous for the child. Due to excessive pressure in the uterus, circulatory disorders in the placenta develop, the fetus suffers from a lack of oxygen, and without timely assistance, severe CNS damage can develop.
- Incipient uterine rupture. At this stage, there is a rupture of the internal layers of the organ – mucous and muscular, with damage to large blood vessels. A woman in labor has chaotic and very painful contractions, vaginal discharge with traces of blood. Hemorrhagic shock develops, which progresses rapidly and can lead to the death of the mother and fetus in a short time.
- Complete hysterorhexis. Damage to all layers of the uterus, in which the organ completely loses its integrity. At this stage, signs of shock predominate: a sharp decrease in blood pressure, confusion, pale skin, weak pulse, shallow breathing, dilated pupils, and vomiting. Shock is the main cause of disruption of all body functions, which makes the prognosis not very favorable. A complete rupture is characterized by a complete cessation of labor activity – the absence of contractions and attempts.
Diagnosis of hysterorhexis is based on symptoms and ultrasound findings. Unfortunately, the time for research is extremely limited, so the doctor has to make an immediate decision to save the life of the woman in labor and the fetus, as well as to exclude serious consequences for their health.
Treatment of uterine rupture
The tactics of treatment directly depends on how far the pathological process has gone.
Acute pain during childbirth may indicate the development of complications
Threatening hysterorhexis is an indication of the rapid cessation of labor. For this, drugs are used, the action of which is aimed at reducing muscle tone and pain relief. Further tactics are determined by the condition of the fetus.
If the vital signs of the fetus are satisfactory or there is a chance of salvation with the help of resuscitation, an emergency caesarean section is performed. If objective symptoms and ultrasound data confirm the death of the fetus, then a craniotomy is performed, that is, the surgical removal of the fetus from the uterus.
With the onset or complete hysterorhexis, an emergency surgical operation is necessary, the purpose of which is to remove the uterus or restore its integrity by suturing the flaps, stopping blood loss and assessing the condition of the abdominal organs.
Forecasts after surgery completely depend on the stage of uterine rupture the woman was assisted with. The sooner treatment is started, the higher the chances of saving the life of the mother and child.
Blood loss is the most dangerous “companion” of hysterorhexis. Therefore, even at the initial stage, an intravenous infusion of blood or its substitutes is carried out in order to prevent violations of the cardiovascular system and the development of shock.
Prevention of uterine rupture
Today there is no special program aimed at reducing the risk of uterine rupture. A number of simple rules of a general nature will help to minimize the development of this condition:
- Determine in advance your personal risks and possible causes of complications. If during the bearing of the first and all previous children, fetal hypoxia, bleeding, difficult childbirth or other similar circumstances were observed, be sure to inform your doctor about this. It is optimal to provide the gynecologist with all medical documentation related to the previous pregnancy.
- Early registration with the LCD will allow you to “buy time” and conduct all the necessary research in the early stages. This, in turn, will help to correct the course of pregnancy and fetal development in time, if any deviations are detected. In addition, if the expectant mother has anomalies in the structure of the birth canal, the doctor will create a program of obstetric care, including a planned caesarean section.
- Follow your doctor’s recommendations. If he considers it necessary to comply with bed rest, limit physical activity or other measures, this is necessary to maintain the pregnancy and its successful completion.
Childbirth may begin earlier than the “official” date. Accordingly, uterine injury may occur earlier. Therefore, even slight signs of deviation cannot be ignored if they are observed several weeks or months before the birth of the child. This is especially important when you have reason to suspect hysterorhexis.
Expectant tactics in such cases can provoke very serious consequences. If you feel unwell, pain and tension in the uterus, contact your doctor immediately.
See also: causes and treatment of uterine perforation