Uterusruptur

Imaging for

acute pelvic pain in pregnancy. A 38-year-old woman was admitted at 26 weeks’ gestation presenting with vomiting and acute abdominal pain. Axial T2-weighted HASTE (a) and T1-weighted fat-saturated sequences (b) show posterior extravasation of amniotic fluid into a hernial sac that contains a small fluid level; these findings are suggestive of a sealed uterine rupture. Note the presence of haemoperitoneum

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Uterine rupture is a rare but nevertheless potentially catastrophic complication that can occur in pregnancy.

Epidemiology

The incidence rate in pregnancy is 0.05% .

Clinical presentation

Uterine rupture is usually an acute presentation with hemodynamic instability and abdominal discomfort.

Pathology

The most common cause (>90%) of uterine rupture is an old Cesarean section scar. Uterine rupture may be limited to dehiscence of the ends of the Cesarean scar with an intact overlying serosal layer. A full-thickness uterine rupture with direct communication of the uterine and peritoneal cavities results in massive hemoperitoneum, and carries high fetal and maternal morbidity and mortality. Classic scars are more likely to rupture before labor, whereas lower uterine segment scars tend to rupture after labor.

Location

In general uterine ruptures tend to favor the anterior lower uterine segment, especially when associated with pregnancy.

Radiographic features

Ultrasound

Reported sonographic signs of uterine rupture include:

identification of the protruding portion of the amniotic sac
endometrial or myometrial defect
intraperitoneal fetal parts
extrauterine hematoma
hemoperitoneum or free fluid

MRI

Multiplanar MR imaging offers a comprehensive assessment of the uterine wall and the peritoneal cavity.

Treatment and prognosis

Uterine rupture is most often an obstetric emergency (especially if associated with pregnancy). Hysterectomy is often required as part of management.