Uterine rupture: Are intrauterine pressure catheters useful in the diagnosis?

Rodriguez, M. Hellen; Masaki, Damon I.; Phelan, Jeffrey P.; Diaz, Fidelia

doi:10.1016/0002-9378(89)90375-x

Cited by 99 publications

(30 citation statements)

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“…They did not describe their definition of hypertonia or which uterine monitoring technique (i.e., TOCO or IUPC) was applied. The retrospective study of Rodriguez et al detected an increased baseline uterine pressure in 10 % ( n = 4) of the uterine rupture cases ( n = 39) which were monitored with an IUPC [29]. …”

Section: Resultsmentioning

confidence: 99%

Tocogram characteristics of uterine rupture: a systematic review

Vlemminx

Lau

Oei

2016

Arch Gynecol Obstet

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PurposeTimely diagnosing a uterine rupture is challenging. Based on the pathophysiology of complete uterine wall separation, changes in uterine activity are expected. The primary objective is to identify tocogram characteristics associated with uterine rupture during trial of labor after cesarean section. The secondary objective is to compare the external tocodynamometer with intrauterine pressure catheters.MethodsMEDLINE, EMBASE, and the Cochrane library were systematically searched for eligible records. Moreover, clinical guidelines were screened. Studies analyzing tocogram characteristics of uterine rupture during trial of labor after cesarean section were appraised and included by two independent reviewers. Due to heterogeneity, a meta-analysis was only feasible for uterine hyperstimulation.ResultsThirteen studies were included. Three tocogram characteristics were associated with uterine rupture. (1) Hyperstimulation was more frequently observed compared with controls during the delivery (38 versus 21 % and 58 versus 53 %), and in the last 2 h prior to birth (19 versus 4 %). Results of meta-analysis: OR 1.68 (95 % CI 0.97–2.89), p = 0.06. (2) Decrease of uterine activity was observed in 14–40 % and (3) an increasing baseline in 10–20 %. Five studies documented no changes in uterine activity or Montevideo units. A direct comparison between external tocodynamometer and intrauterine pressure catheters was not feasible.ConclusionsUterine rupture can be preceded or accompanied by several types of changes in uterine contractility, including hyperstimulation, reduced number of contractions, and increased or reduced baseline of the uterine tonus. While no typical pattern has been repeatedly reported, close follow-up of uterine contractility is advised and hyperstimulation should be prevented.

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Section: Resultsmentioning

confidence: 99%

Tocogram characteristics of uterine rupture: a systematic review

Vlemminx

Lau

Oei

2016

Arch Gynecol Obstet

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“…Other potential clinical manifestations include maternal tachycardia, hypotension ranging from subtle to severe (hypovolemic shock), cessation of uterine contractions, loss of station of the fetal presenting part, uterine tenderness, and change in uterine shape. Intuitively, loss of integrity of the uterine wall should be associated with a reduction in intrauterine pressure [5,6].…”

Section: Uterine Rupture Typically Is Classified As Eithermentioning

confidence: 99%

Maternal and Perinatal Outcomes of Uterine Rupture Patients among Mothers who Delivered at Mizan Aman General Hospital, SNNPR, South West Ethiopia; A Five Year Retrospective Hospital Based Study

Mengistie¹

2016

MOJWH

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Background: Uterine rupture causes high maternal and perinatal mortality in many rural setting in the world. Ethiopia is one of the less developed countries where maternal and perinatal mortality rates are still very high.Objective: To determine maternal and perinatal outcomes of uterine rupture patients among mothers who delivered at Mizan-Aman General Hospital, South west Ethiopia. Methods:A descriptive hospital based cross sectional study on maternal and perinatal outcome of uterine rupture patients among mothers who delivered at Mizan-Aman General Hospital was done from June 1, 2011 -May 31, 2015. Data on socio demographic, obstetrics, intraoperative, post op complication, maternal and perinatal outcome was collected. The collected data analyzed with SPSS 20.0. Association between dependent and independent variables was done by using binary logistic regression model and P-Value <0.05 at 95% CI was taken as statistically significant.Result: 115 patient cards were included in the study. There were 1(8.3%) intra operative maternal death and 11(91.7 %) post-operative death, making case fatality rate of uterine rupture 10.4 %. The incidence of uterine rupture in the hospital was 1.6%. There were 110(95.6%) of neonatal death and 5(4.6%) of neonate were delivered alive, those delivered with instrument and from previous uterine scar. The common causes of uterine rupture were obstructed labor 57(49.6%) followed by malpresentation and malposition which account 26(22.6%). Of all uterine rupture patients 102(88.7%) were complete rupture, the common site of rupture were 38(33%) anterior transverse lower segment followed by anterior low vertical 22(19.1%). Repair with bilateral tubal ligation in 48(41.7%) followed by repair without bilateral tubal ligation in 34(29.6%) were the common procedures done for ruptured uterus patients. Conclusion:Hemoglobin level, blood transfusion, diagnosis of uterine rupture before operation had strong association with maternal out come and neonatal intensive care unit admission had also strong association with perinatal outcome.The common causes of uterine rupture are obstructed labor followed by malpresentation/ position. Complete uterine rupture and anterior lower segment rupture were by far the commonest patterns of uterine rupture by type and site respectively.

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“…The presence of an intra-uterine pressure catheter and subsequent alterations in readings has been suggested as a method of diagnosis for uterine rupture. However, this also lacks sensitivity [11].…”

Section: Discussionmentioning

confidence: 99%

Rupture of the Unscarred Gravid Uterus: Case Series

O’Sullivan¹,

Sauer²,

Friedman³

et al. 2015

J Med Cases

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Rupture of the unscarred uterus is estimated to occur in approximately 0.8 in 10,000 deliveries. It is a potentially catastrophic event for both mother and fetus. We present two such cases and review the relevant literature. The first case concerns a multiparous patient who attended due to reduced fetal movements and subsequently incurred fetal demise, sepsis and significant hemorrhage. The second case concerns a patient in her second delivery who developed uterine rupture after a prolonged second stage of labor. We recommend that clinicians maintain a high index of suspicion for uterine rupture even in the absence of prior cesarean delivery.

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Uterine rupture: Are intrauterine pressure catheters useful in the diagnosis?

Cited by 99 publications

References 1 publication

Tocogram characteristics of uterine rupture: a systematic review

Tocogram characteristics of uterine rupture: a systematic review

Maternal and Perinatal Outcomes of Uterine Rupture Patients among Mothers who Delivered at Mizan Aman General Hospital, SNNPR, South West Ethiopia; A Five Year Retrospective Hospital Based Study

Rupture of the Unscarred Gravid Uterus: Case Series

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