TREATMENT :
The most critical aspects of treatment in the case of uterine rupture are establishing a timely diagnosis and minimizing the time from the onset of signs and symptoms until the start of definitive surgical therapy. Once a diagnosis of uterine rupture is established, the immediate stabilization of the mother and the delivery of the fetus are imperative. After the fetus is delivered, the type of surgical treatment for the mother should depend on the following factors:
Type of uterine rupture
Extent of uterine rupture
Degree of hemorrhage
General condition of the mother
Mother's desire for future childbearing
Uterine bleeding is typically most profuse when the uterine tear is longitudinal rather than transverse. Conservative surgical management involving uterine repair should be reserved for women who have the following findings:
Low transverse uterine rupture
No extension of the tear to the broad ligament, cervix, or paracolpos
Easily controllable uterine hemorrhage
Good general condition
Desire for future childbearing
No clinical or laboratory evidence of an evolving coagulopathy
Hysterectomy should be considered the treatment of choice when intractable uterine bleeding occurs or when the uterine rupture sites are multiple, longitudinal, or low lying.
As a rule, the time available for successful intervention after frank uterine rupture and before the onset of major fetal morbidity is only 10-37 minutes. Therefore, once the diagnosis of uterine rupture is considered, all available resources must quickly and effectively be mobilized to successfully institute timely surgical treatment that results in favorable outcomes for both the newborn and mother.
Because of the short time available for successful intervention, the following 2 premises should always be kept firmly in mind: (1) Maintain a suitably high level of suspicion regarding a potential diagnosis of uterine rupture, especially in high-risk patients. (2) When in doubt, act quickly and definitively.