What are the symptoms of uterine rupture? How to detect it?

Uterine rupture may occur in the late stages of pregnancy, before delivery, but more often it occurs when delivery is approaching, causing delivery to become difficult. The main symptoms are prolonged labor, inability of the fetal head or presenting part to enter the pelvis, etc.

(1) Complete uterine rupture : refers to the rupture of the entire thickness of the uterine wall, which allows the uterine cavity to communicate with the abdominal cavity. At the moment when the uterus ruptures completely, the mother often feels severe tearing abdominal pain, followed by the disappearance of uterine contractions and the relief of pain. However, as blood, amniotic fluid and fetus enter the abdominal cavity, persistent whole-abdominal pain appears, and the mother develops symptoms and signs of shock such as pale complexion, cold sweats, shallow breathing, weak pulse, and low blood pressure.

During the examination, there is tenderness and rebound pain in the entire abdomen. The fetal body can be clearly felt under the abdominal wall. The uterus is shrunken and located to the side of the fetus. The fetal heartbeat disappears. There may be fresh blood flowing out of the vagina, which may be more or less. The presenting part of the fetus disappears during exposure or descent (the fetus enters the abdominal cavity), and the once dilated cervix may retract. When the anterior wall of the uterus ruptures, the tear can extend forward and cause bladder rupture. If there is a lot of bleeding in the abdominal cavity, shifting dullness may be heard. If uterine rupture has been confirmed, there is no need to examine the uterine rupture through the vagina. If the uterus ruptures due to oxytocin injection, the mother will feel strong contractions of the uterus after the injection, sudden severe pain, and the presenting part will rise and disappear immediately. Abdominal examination will show the same findings as above.

(2) Incomplete uterine rupture: refers to the complete or partial rupture of the uterine muscle layer, the serosal layer has not been pierced, the uterine cavity and the abdominal cavity are not connected, and the fetus and its appendages are still in the uterine cavity. During abdominal examination, there will be tenderness at the site of incomplete rupture of the uterus. If the rupture occurs between the two leaves of the broad ligament of the side wall of the uterus, an intra-broad ligament hematoma may form. At this time, a gradually enlarging and tender mass can be felt on one side of the uterine body. Fetal heart sounds are often irregular. If the uterine artery is torn, it can cause severe extraperitoneal bleeding and shock. Abdominal examination showed that the uterus still maintained its original shape, with obvious tenderness after rupture, and a gradually enlarging hematoma could be felt on one side of the abdomen. Broad ligament hematoma can also extend upward to become a retroperitoneal hematoma. If the bleeding does not stop, the hematoma may penetrate the serosa and cause complete uterine rupture.