Uterine rupture remains one of the most frightening complications in obstetric care. The risk of its occurrence is likely to increase for many women who undergo caesarean sections.
It is important to consider because it continues to be associated with maternal and foetal mortality, especially in developing countries, and with major maternal morbidity, particularly peripartum hysterectomies.
Maternal outcomes following uterine rupture include hysterectomy, bladder injuries, transfusion, ICU admission, shock, assisted ventilation, and an increase in hospital length of stay.
Diagnosis of uterine rupture
The diagnosis of uterine rupture is principally based on clinical manifestations, foetal heart abnormalities, or imaging examinations before or after delivery.
There should be a higher index of suspicion by the healthcare provider, in order to identify the rupture as early as possible, and provide immediate surgical treatment.
The main reason that a patient is pre-disposed to uterine rupture is weakness of the muscle layer of the inferior segment of the uterus after caesarean section, or after scarring of any sort, in this area.
It is also associated with obstructed labour, prolonged labour, the use of induction agents, malpresentation, and grand multiparity.
Deliver the baby as soon as possible
The key message is that the delivery of the baby should be done as soon and as safely possible if a uterine rupture is suspected.
If the rupture is suspected after delivery, an immediate response for management and treatment should start. Stabilising the patient clinically with transfusions, medications and proper intravenous access should be done concomitantly with preparation of the operating room theatre and a well-trained team.
A major decision facing the surgeon will be whether to preserve the uterus with a repair, or perform a hysterectomy.
Obviously, the patient’s desire for future pregnancies is important, but this may be superseded by the emergent need to perform life-saving measures such as hysterectomy.
The traditional approach is to perform a laparotomy, and either repair the uterine defect or remove the uterus. It is very important once inside to control the haemorrhage and identify damage to adjacent organs, most likely the bladder.
Minimally invasive techniques using laparoscopy or keyhole surgery have been described in the literature. These will allow a faster recovery with less pain, and a decrease in postoperative wound complications.
da Vinci Xi HD 4 arm robotic system
Recently at Mediclinic City Hospital, Dubai, Dr Labib Riachi, an expert in advanced robotic gynaecological surgery, and his team performed a repair of a uterine rupture using the da Vinci Xi HD 4 arm robotic system which enabled them to use the most advanced surgical techniques available worldwide. This allowed an unparalleled level of high precision in manipulating torn tissues, as well as a three-dimensional view of the field, with the freedom to rotate the instruments independently without any assistance. The repair was done successfully in 30 minutes. Following surgery, the patient was taken to a regular ward and recovered with no complications.
Dr Labib Riachi is a Consultant Obstetrician & Gynaecologist. He specialises in Minimally Invasive Gynaecological Surgery, Obstetrics and Gynaecology and Urogynaecology
- View Dr Labib Riachi’s Mediclinic profile here:
https://www.mediclinic.ae/en/city-hospital/ specialized-units/da-vinci-robotic-surgery-system.doctor.html/8/labib-riachi.html
