Uterine rupture is a rare but catastrophic obstetric complication occurring in pregnancy or in labor with an incidence of 1 in 1536 (0.07%) that results in high fetal mortality. Vast majority of uterine ruptures occur in scarred uterus, while spontaneous rupture in unscarred uterus is a less common occurrence and has further reduced due to better obstetric care. The diagnosis of rupture uterus is difficult and requires high index of suspicion in all high-risk cases. Persistent and prolonged fetal bradycardia accompanied by abdominal pain, abnormal progress of labor, and vaginal bleeding strongly point toward scar dehiscence or scar rupture. The treatment involves resuscitation and laparotomy with either obstetric hysterectomy or repair of the uterine rupture. Surgical intervention preferably by senior or experienced obstetrician in less than 10–37 min is crucial to minimize maternal and fetal morbidity and mortality. Labor room should be well equipped to handle such emergencies, and obstetric emergency drill training should be regularly practiced by the labor room team.
KeywordsScarred uterus Rupture uterus Spontaneous rupture Obstructed labor VBAC Prior cesarean section
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