21.4 Ruptured uterus
Bleeding from a ruptured uterus may occur from the vagina so you can see the blood flowing out, or the uterus may bleed into the woman’s abdomen where the blood won’t be visible to you. If a woman who has been a long time in labour develops abdominal pain that is constant and gets worse with movement, or if, the uterus stops its contraction in the effort of expulsing the fetus, or she develops vaginal bleeding with associated state of shock, it is likely that the uterus has ruptured. If the uterus stops contracting, the abdomen will become soft and the fetal parts can be felt easily when you do an abdominal examination. If the baby has died the fetal heartbeat will not be evident when you listen with a fetoscope.
You will learn much more detail about the condition of the ruptured uterus in the next module in this curriculum, on Labour and Delivery Care. If you encounter a woman with the signs of a ruptured uterus you should take the emergency actions described below.