10.3.1  Warning signs of imminent uterine rupture

Box 10.1 shows the common warning signs of imminent uterine rupture. These are the best indicators that the labour is obstructed and that, unless the baby is quickly delivered by surgical operation, the uterus is very likely to rupture soon.

Box 10.1  Warning signs of uterine rupture

  • Frequent, strong uterine contractions, occurring more than 5 times in every 10 minutes, and/or each contraction lasting 60–90 seconds or longer.
  • Fetal heart rate above 160 beats/minute, or below 120 beats/minute, persisting for more than 10 minutes – this is often the earliest sign of obstruction affecting the fetus.
  • Bandl’s ring formation (see Study Session 9 and Figure 10.1).
  • Tenderness in the lower segment of the uterus.
  • Possibly also vaginal bleeding.
A normal abdominal contour (left) and an obstructed uterus with Bandl’s ring (right), indicating imminent risk of rupture.
Figure 10.1  A normal abdominal contour (left) and an obstructed uterus with Bandl’s ring (right), indicating imminent risk of rupture.

  • How can the partograph aid you in spotting the potential imminence of uterine rupture?

  • Since you use it to chart the frequency and duration of contractions, as well as changes to the fetal heartrate, you will quickly see if either of these is in the warning zone indicated in Box 10.1 above.

10.3  Clinical features and consequences of ruptured uterus

10.3.2  Signs that the uterus has ruptured