Patient's question:
I am a remarried woman and would like to have a third child. My first two pregnancies were via C-section, and it has been 6 years since my second one. I am now 21 weeks pregnant. I would like to ask the good doctors how I can prevent uterine rupture.Doctor's answer:
(1) Complete uterine rupture: The entire uterine wall tears open, with amniotic fluid, placenta, and part or all of the fetus being pushed into the abdominal cavity. When rupture occurs, the mother suddenly feels sharp abdominal pain resembling a tearing sensation, followed by the cessation of contractions and a sudden relief of abdominal pain. Soon after, with amniotic fluid and fetal blood entering the abdominal cavity, persistent diffuse abdominal pain appears. The mother may exhibit symptoms and signs of shock, such as pale complexion, cold sweat, shallow breathing, thready pulse, and hypotension. Fresh blood may flow from the vagina, with varying amounts. The presenting part of the fetus, which was previously visible or descending, disappears, and the dilated cervix retracts. If the anterior wall of the uterus ruptures, the tear may extend forward, potentially causing bladder rupture. Abdominal examination reveals diffuse tenderness and rebound tenderness, with the fetal limbs clearly palpable beneath the abdominal wall. Fetal heart sounds disappear, and the uterine shape cannot be palpated. Sometimes, a shrunken uterus can be felt on one side of the fetal body. If there is significant intra-abdominal bleeding, shifting dullness can be percussion. Vaginal examination may reveal the presenting part rising, cervical constriction, and sometimes the rupture site can be palpated within the uterine cavity.