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RUPTURED UTERUS
Bleeding from a ruptured uterus may occur vaginally unless
the fetal head blocks the pelvis. Bleeding may also occur
intra-abdominally. Rupture of the lower uterine segment
into the broad ligament, however, will not release blood into
the abdominal cavity.
| 1 |
Restore
blood volume by infusing IV fluids (normal saline or
Ringer’s lactate) before surgery. |
| 2 |
When
stable, immediately perform laparotomy and deliver the
baby and
placenta. |
| 3 |
If
the uterus can be repaired with less operative risk than
hysterectomy would entail and the edges of the tear are
not necrotic, repair the uterus. This involves less time
and blood loss than hysterectomy. |
| 4 |
If
the uterus cannot be repaired, perform subtotal hysterectomy.
If the tear extends through the cervix and vagina, total
hysterectomy may be required. |
Because there is an increased risk of rupture with subsequent
pregnancies, discuss the option of permanent contraception
with the woman after the emergency is over.
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