Learning Radiology xray montage

Uterine Rupture



  • Most common in patients with previous cesarean delivery scars
    • Rupture in the absence of a previous scar is uncommon
  • Uterine trauma may occur following very prolonged or vigorous labor
    • Especially if patient has relative or absolute cephalopelvic disproportion, and
      Uterus has been stimulated with oxytocin or prostaglandins
  • Trauma may result secondary to attempts to remove a retained placenta manually or with instrumentation
  • Location
    • Corpus with rupture before onset of labor
    • Lower uterine segment during labor

Risk factors

  • Patients with prior classic hysterotomy have higher rate of uterine rupture in subsequent pregnancies
    • Those who have had 2 or more hysterotomies
  • Those who are treated with prostaglandin agents and have undergone a previous caesarian have highest risk
  • Those who undergo induction of labor have small increased risk

Clinical findings

  • Acute abdominal pain
  • “Popping” sensation
  • Palpation of fetal parts outside of the confines of the uterus
  • Repetitive or prolonged fetal heart rate deceleration
  • Vaginal bleeding ─ early post-partum hemorrhage

Diagnosis is clinical

  • Ultrasound may be useful if immediately available


  • Presence of uterine rupture dictates laparotomy be performed
  • Treatment consists of immediate cesarean delivery with probable hysterectomy.
  • Repair of uterus may be possible in some cases


  • 2-20% maternal mortality
  • 10-25% fetal mortality

  uterine rupture

Uterine rupture. Contrast-enhanced CT scan through the pelvis demonstrates the non-involuted uterus with a large discontinuity representing the rupture in the right posterolateral wall (blue arrow). There is a considerable amount of blood (red arrow) in the pelvis. The pelvic veins are dilated from the recent pregnancy.