Clinical Presentation

Early identification of uterine rupture and immediate intervention is key to reducing morbidity and mortality related to uterine rupture. The following are signs/symptoms that may suggest uterine rupture:

Maternal signs/symptoms

  • Unstable vitals – Hypotension, tachycardia, decreased LOC
  • Pain– intense abdominal pain that persists between contractions (this may be masked by neuraxial analgesia), abdominal peritonitis like rigidity, rebound tenderness
  • Bleeding- vaginal bleeding may or may not be present, depending on where the rupture has occurred
  • Change in abdominal shape- there may be change in the abdominal girth, shape 
  • Palpation of fetal part in abdomen
  • Inability to palpate fundus (if fundal rupture has occurred)
  • Cessation of uterine contractions
  • Free fluid in the abdomen on bedside ultrasound

Fetal signs

  • Fetal heart rate changes- commonly bradycardia with no recovery due to loss of blood supply is the most common objective sign, can also present with variable or late decelerations
  • Loss of station- if rupture has occurred, the fetus may have passed through the rupture into the abdominal cavity and present as a loss of station.

Uterine rupture can also occur post delivery. It is important to do a bimanual exam after delivery to ensure the uterus is intact, particularly if there is significant bleeding post delivery.

Updated on November 3, 2021

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