10.3.3 Consequences for the mother
The consequences of the rupture for the mother depend on the extent of the blood loss, how much time has passed since the rupture occurred, and whether her abdominal cavity and blood system are infected.
Extent of blood loss
Uterine rupture by its nature is a trauma to the uterine tissue where there will be tearing of uterine muscles and blood vessels. If the rupture involves major blood vessels, particularly uterine arteries, the blood loss will be massive. Unless rapid emergency intervention occurs, the blood loss will almost certainly cause the death of the fetus, and the mother will be in severe haemorrhagic shock (described below), which will be followed by her death. If the rupture occurs in an area of the uterus where major blood vessels aren’t involved, the woman has a greater chance of survival.
The duration of the rupture
It often happens that rural women, who are not haemorrhaging excessively and whose condition does not appear to them or their families to be immediately life-threatening, will remain at home for hours, even days, after the uterus has ruptured. However, the longer the woman remains untreated with a ruptured uterus, the higher the chance of greater blood loss, acute kidney failure and infection which has disseminated (spread) throughout her body.
Presence of established infection
A ruptured uterus means there is direct communication between the birth canal and the abdominal cavity. Other internal organs, including parts of the intestines, rectum and bladder may also have been damaged and be leaking their contents into the abdomen. As a result, microorganisms can easily spread around the whole of the abdominal cavity, and enter the blood circulation through the ruptured blood vessels. The development of infection in the abdominal cavity is called peritonitis; infection disseminated around the body in the blood circulation is called septicaemia. If the woman survives the initial rupture but remains untreated for more than about 6 hours, the risk of one or both of these conditions occurring is very high indeed. Therefore, early recognition that a rupture has occurred and early referral are of paramount significance in saving the life of the mother.
Depending on the extent of blood loss, duration of time since the rupture and status of any infection, the woman with a ruptured uterus may develop some or all of the complications described below.
The signs of this rapidly fatal condition are that the mother has or feels:
- Faint, dizzy, weak or confused
- Pale skin and cold sweats
- Fast pulse (above 100 beats/minute) or too fast to be recordable
- Rapidly dropping or unrecordable blood pressure
- Fast breathing (above 30 breaths/minute)
- Sometimes loss of consciousness
- Significantly reduced or absent urine output.
This occurs if the rupture and haemorrhage have resulted in septicaemia. The signs are the same as for haemorrhagic shock, but with the addition of high grade fever (above 38oC).
- Peritonitis: infection in the abdominal cavity.
- Acute kidney failure due to low blood volume.
- Almost all cases coming to hospitals will be managed by removing the uterus (a hysterectomy), so the woman will be unable to have more children.
What happens to the fetus at the stage of an imminent ruptured uterus and immediately afterwards?
Before the rupture its heart rate is persistently above 160 beats/minute, or below 120 beats/minute. After the rupture the uterus wraps itself around the fetus, and with blood draining into the abdominal cavity, it quickly dies unless there is immediate surgery to remove it.
10.3.2 Signs that the uterus has ruptured
10.4 Interventions in ruptured uterus