History

Fact Explanation
History of previous cesarean section Uterine ruptures mostly occur due to previous cesarean sections. Risk of rupture in classical (vertical) incision is greater than transverse one in subsequent pregnancies.[3].The incidence of uterine rupture has dropped significantly in developed countries and is most often encountered while attempting vaginal birth after caesarean section (CS).[2]. Theoretically, any prior uterine insult, spanning from uterine perforation during curettage to myomectomy (laparoscopic or via laparotomy) or Caesarean section, can lead to a uterine wall weakness and an increased risk for uterine rupture in a subsequent pregnancy.[9].
History of malpresentation, multiple pregnancy and multiparity Multiple pregnancy is a known causes of uterine rupture in unscarred uterus.[2]. And assisted breech delivery and malpresentation also found to be significantly higher among women with UR.[1]. Other Causes of uterine rupture in unscarred uterus are grand multiparity, injudicious use of oxytocin, neglected labour, uterine instrumentation and manipulation, labour induction, congenital abnormalities of uterus and uterine distension due to polyhydramnios, [2].
History of inadequate scar healing Uterine damage resulting from the use of electrocautery led to increased risk of adhesion formation.In addition to more adhesions, the inflammation and necrosis associated with electrocautery may lead to delayed healing and a weaker uterine scar, predisposing women in a subsequent pregnancy to an increased risk of uterine scar dehiscence or rupture.[9]. Unhealthy tissue remaining after uterine repair may predispose to problems like infection, DIC, abscess formation and hemorrhage.And also increase the risk of recurrent rupture.[1].
Abdominal pain They experienced abdominal pain. It is a sharp pain between contractions.[3]. A continuous abdominal pain with absence of contraction indicating UR has also been reported.[6]. A complete uterine rupture cannot usually be predicted and it will suddenly occur during labor or delivery. Termination of pregnancy should be considered if any sudden pain is present.Onset of sharp pain at the site of previous scar also has also been reported.[3].
Vomiting Clinical signs of UR in early pregnancy are nonspecific and must be distinguished from acute abdominal emergencies. Abdominal pain, vaginal bleeding, and vomiting are classic findings.[7].
Bleeding Vaginal bleeding is a classic finding of UR.[7]. Even though in developed countries where fetal heart rate abnormalities are the first identified manifestations of uterine rupture, late signs like vaginal bleeding (43.9%) are common in developing countries.[5]. Sometimes it may lead to life threatening severe uterine bleeding.[6]. Unscared uterine rupture (UUR) usually occurs in the lower segment (the weakest part) of uterus. If the rupture part is fundus, the diagnosis is often delayed because the haemorrhage is not revealed immediately, as blood collects in the intraperitoneal space.[7].
Vesicovaginal fistula Uterine rupture may leave surviving patients with term complications like vesicovaginal fistula and inability to deliver children.[2].
Blood stained urine A rare presentation.UR can also leads to associated bladder rupture [2].
DIC A complication of UR. One of the common cause of maternal death following UR is disseminated intravascular coagulation (DIC) or irreversible shock.[2].
Acidosis A neonatal complication of UR. There are reported cases of acidosis needing admission in neonatal Intensive care unit (ICU).[2].
Birth asphyxia A fetal complication of uterine rupture. Birth asphyxia can occurred commonly in infants delivered after 17 minutes of onset of deceleration. Some of them undergone temporary neonatal intubation [4]. Some developed severe birth asphyxia that needing neonatal intensive care.[2].
Intrauterine death Rupture of the gravid uterus is an unexpected and devastating complication of pregnancy with high maternal and fetal mortality and morbidity. Even though it can be prevented in most cases, rates of maternal and perinatal morbidity and mortality are still high. Intrauterine death rate is high in rupture of the unscared uterus than the scared uterus.Rupture of the unscarred uterus carries more hazardous fetomaternal risks compared to scarred uterus.[1]. Uterine rupture can lead to fetal brain injury or death.[4]. Complete uterine rupture in which the fetus was already extruded into the peritoneal cavity was observed in most cases (88.4%). In these cases, majority of the fetus were dead, reflecting the high perinatal mortality rate. [8].
Maternal death In the literature, maternal mortality rate can be as high as 13.5%, whereas several other studies from developing countries have reported lower rates.Death may have occurred prior to the admission to the hospital. Hypovolemic shock is claimed to be the main cause of death and rapid transfer of these patients to tertiary care centers[1].
References
  1. TURGUT A, OZLER A, SIDDIK EVSEN M, ENDER SOYDINC H, YAMAN GORUK N, KARACOR T, GUL T. Uterine rupture revisited: Predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey Pak J Med Sci [online] 2013, 29(3):753-757 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809304
  2. QAZI Q, AKHTAR Z, KHAN K, KHAN AH. Woman Health; Uterus Rupture, Its Complications and Management in Teaching Hospital Bannu, Pakistan Maedica (Buchar) [online] 2012 Jan, 7(1):49-53 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484796
  3. AHMADI F, SIAHBAZI S, AKHBARI F. Incomplete Cesarean Scar Rupture J Reprod Infertil [online] 2013, 14(1):43-45 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719360
  4. GUISE JM, MCDONAGH MS, OSTERWEIL P, NYGREN P, CHAN BK, HELFAND M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section BMJ [online] 2004 Jul 3, 329(7456):19-25 [viewed 20 August 2014] Available from: doi:10.1136/bmj.329.7456.19
  5. FOFIE C, BAFFOE P. A Two-Year Review of Uterine Rupture in a Regional Hospital Ghana Med J [online] 2010 Sep, 44(3):98-102 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996838
  6. JANG DG, LEE GS, YOON JH, LEE SJ. Placenta Percreta-Induced Uterine Rupture Diagnosed By Laparoscopy in the First Trimester Int J Med Sci [online] , 8(5):424-427 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149421
  7. TOLA ESRA NUR. First Trimester Spontaneous Uterine Rupture in a Young Woman with Uterine Anomaly. Case Reports in Obstetrics and Gynecology [online] 2014 December, 2014:1-3 [viewed 20 August 2014] Available from: doi:10.1155/2014/967386
  8. IGWEGBE AO, ELEJE GU, UDEGBUNAM OI. Risk factors and perinatal outcome of uterine rupture in a low-resource setting Niger Med J [online] 2013, 54(6):415-419 [viewed 20 August 2014] Available from: doi:10.4103/0300-1652.126300
  9. HASBARGEN U.. Uterine dehiscence in a nullipara, diagnosed by MRI, following use of unipolar electrocautery during laparoscopic myomectomy: Case report. [online] 2002 August, 17(8):2180-2182 [viewed 21 August 2014] Available from: doi:10.1093/humrep/17.8.2180

Examination

Fact Explanation
Abdominal tenderness Uterine rupture usually occurs at the site of deficient cesarean scars. The majority of fenestrations or incomplete uterine ruptures are asymptomatic and may initially be quite subtle and may be seen during the process of future cesarean sections or laparotomies . The majority of cesarean uterine incisions are low-transverse and this type of incision has the lowest risk for rupture in subsequent pregnancies .The classical (vertical) scar at the upper part (body) of the uterus is more vulnerable to ruptures and can cause more serious complications both for the mother and her baby.[6] Abdominal tenderness is a common finding in UR of a scarred uterus.[1].
Fetal distress/ Bradicardia Abdominal tenderness and fetal distress are more common in the scarred uteri.[1]. In developed countries fetal heart rate abnormalities are the first identified manifestations of uterine rupture.[3]. Abnormalities in fetal heart rate were the most common sign of rupture, occurring in 55-87% of uterine rupture events. Fetal bradicardia and prolonged deceleration may occur. Usually no prolonged clinical morbidity (death, asphyxia, or intubation) occurred when delivery took place within 17 minutes of onset of deceleration[7].
Hypovolemic shock Hypovolemic shock is claimed to be the main cause of death and rapid transfer of these patients to tertiary care centers is imperative.[1]. The symptoms of incomplete rupture differ totally from those of complete rupture.In incomplete rupture, the symptoms can be minimal and so obscured as to lead us to almost inevitable diagnostic errors.In complete rupture, the symptoms are usually dramatic. To the primary shock due to the rupture are added the signs of an important internal hemorrhage.[2].
Sudden increase in maternal pulse The most common presentation is intrapartum, but rupture can be diagnosed ante or postpartum. Intrapartum events are usually detected after a sudden increase in maternal pulse rate and a decrease in blood pressure together with vaginal bleeding and abdominal pain followed by fetal bradycardia.[5].
Palpable fetal parts The signs and symptoms of uterine rupture, largely depending on timing, site and extent of uterine defect, are severe hemorrhage, palpable fetal parts, recession of presenting fetal parts.[4].
Internal loops or parts of the greater omentum in the uterine cavity If there is sufficient cervical dilatation, the vaginal examination may reveal intestinal loops or parts of the greater omentum in the uterine cavity.[2].
Cessation of contractions Uterine ruptures could be divided into complete and incomplete (dehiscence) ruptures. In incomplete uterine rupture or dehiscence, the myometrium is disrupted but the serosa is intact. Full thickness tears of uterine wall result in complete uterine ruptures. These ruptures mostly occur at the level of prior anterior low cesarean sections.[6].The contractions cease and some part of the fetus can usually be palpated.[2].
Dyspnoea Considerable abdominal distension with dyspnoea, caused by the compression of the thoracic cavity.[2].
Hypotension Uterine ruptures mostly occur due to previous cesarean sections. Risk of rupture in classical (vertical) incision is greater than transverse one in subsequent pregnancies.[6]. Modes of presentation in Uterine rupture (UR) may differ in scarred and unscarred uteri. Hypotension and intrauterine death occur frequently in the unscarred UR.[1].
Anemia Severe anemia and vaginal bleeding are also common presentations. Most women with uterine rupture required blood transfusion. That is probably due to the poor haemodynamic state and the high prevalence of anaemia in pregnancy.[3].
Recession of presenting fetal parts Recession of the fetal head can be seen. That means baby's head moving back up into the birth canal.[6].
Abdominal distension There will be a considerable abdominal distension together with uterine rupture.[2].
Bulging under the pubic bone Bulging under the pubic bone can be identified. Baby's head protrudes out of the uterine scar.[6].
References
  1. TURGUT A, OZLER A, SIDDIK EVSEN M, ENDER SOYDINC H, YAMAN GORUK N, KARACOR T, GUL T. Uterine rupture revisited: Predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey Pak J Med Sci [online] 2013, 29(3):753-757 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809304
  2. BISSON C. SPONTANEOUS UTERINE RUPTURE Can Med Assoc J [online] 1947 Dec, 57(6):583-585 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1590711
  3. FOFIE C, BAFFOE P. A Two-Year Review of Uterine Rupture in a Regional Hospital Ghana Med J [online] 2010 Sep, 44(3):98-102 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996838
  4. QAZI Q, AKHTAR Z, KHAN K, KHAN AH. Woman Health; Uterus Rupture, Its Complications and Management in Teaching Hospital Bannu, Pakistan Maedica (Buchar) [online] 2012 Jan, 7(1):49-53 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484796
  5. KURDOGLU MERTIHAN, KOLUSARI ALI, YILDIZHAN RECEP, ADALI ERTAN, SAHIN HANIM GULER. Delayed diagnosis of an atypical rupture of an unscarred uterus due to assisted fundal pressure: a case report. Array [online] 2009 December [viewed 20 August 2014] Available from: doi:10.1186/1757-1626-2-7966
  6. AHMADI F, SIAHBAZI S, AKHBARI F. Incomplete Cesarean Scar Rupture J Reprod Infertil [online] 2013, 14(1):43-45 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719360
  7. GUISE JM, MCDONAGH MS, OSTERWEIL P, NYGREN P, CHAN BK, HELFAND M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section BMJ [online] 2004 Jul 3, 329(7456):19-25 [viewed 20 August 2014] Available from: doi:10.1136/bmj.329.7456.19

Differential Diagnoses

Fact Explanation
Ectopic pregnancy Clinical signs of UR in early pregnancy are nonspecific and must be distinguished from acute abdominal emergencies.The most relevant differential diagnosis is ectopic pregnancy.[1].Ectopic pregnancy causes major maternal morbidity and mortality, with pregnancy loss, and its incidence is increasing worldwide. Although a proportion of women with ectopic pregnancy have no identifiable causal factors, the risk is increased by several factors such as previous ectopic pregnancy, tubal damage from infection or surgery, a history of infertility, treatment for in vitro fertilization, increased age and smoking. The incidence of ectopic pregnancy is increasing, mainly due to the increased incidence of pelvic inflammatory disease caused by Chlamydia trachomatis. Ectopic pregnancies usually present after seven (SD two) weeks of amenorrhoea. The diagnosis can be difficult unless the condition is suspected. The abdominal pain is usually lateral. However, history and physical examination alone do not reliably diagnose or exclude ectopic pregnancy, as up to 9% of women report no pain and 36% lack adnexal tenderness. The presence of known risk factors can increase suspicion, but any sexually active woman presenting with abdominal pain and vaginal bleeding after an interval of amenorrhoea has an ectopic pregnancy until proved otherwise. Women who present in a collapsed state usually have had prodromal symptoms that have been overlooked. Tubal rupture is rarely sudden since it is due to invasion by the trophoblast.[2].
Ruptured corpus luteal cyst Corpus luteum cyst rupture with consequent hemoperitoneum is a common disorder in women in their reproductive age. This condition should be promptly recognized and treated because a delayed diagnosis may significantly reduce women's fertility and intra-abdominal bleeding may be life-threatening. Acute pelvic pain in women of childbearing age is a common presentation.Physical examination will reveal tachycardia tachypnea, hyperpyrexia , abdominal distention and hypotension.The diagnosis of ruptured corpus luteal cyst is based on a high historical suspicion,clinical features, and laboratory tests. The latter often show anemia, raised CRP, and mild leukocytosis. These signs and symptoms are similar to gastrointestinal tract diseases. Patients may present a wide range of clinical signs, from no signs to severe peritoneal irritation which can be confused with, for example, acute appendicitis. The evaluation of serum βhCG-levels is necessary to differentiate ruptured corpus luteal cyst from ruptured ectopic pregnancy, which may have a similar presentation.[1],[3].
Molar pregnancy Gestational trophoblastic disease (GTD) is a tumor originating from the trophoblast, which surrounds the blastocyst and develops into the chorion and amnion. The main types of gestational trophoblastic diseases are hydatidiform mole (complete or partial) invasive mole, choriocarcinoma placental site trophoblastic tumor.The most common form of GTD is hydatidiform mole, also known as molar pregnancy. There are 2 types of hydatidiform moles, complete and partial.The diagnosis of a molar pregnancy might be suspected based on a number of clinical features. Abnormal vaginal bleeding in early pregnancy is the most common presentation. Other features include uterus large for dates (25%), pain from large benign theca lutein cysts (20%), vaginal passage of grape like vescicles (10%), exaggerated pregnancy symptoms including hyperemesis (10%), hyperthyroidism (5%) and early preeclampsia (5%).[1],[4].
Appendicitis The mainstay of diagnosis of appendicitis remains a detailed history and careful physical examination. They may have nonspecific symptoms. For example, irritability and restlessness. Associated illness, for example, upper respiratory tract infection, otitis media, and gastroenteritis are often present and this may further confuse the clinical picture.Vomiting is a most frequent symptom. Abdominal pain is not invariably a feature of acute appendicitis but is the next most common symptom. It is more likely to be central than confined to the right iliac fossa. Shift of pain is also less likely in the preschool child. Aggravation of pain by movement and coughing is good evidence of peritoneal irritation. Anorexia, poor feeding, and loss of appetite are also good indicators of an intra abdominal inflammatory process. Sleep disturbance may be present in over half of cases.Examination may reveal tachycardia, fever, local tenderness and diffuse tenderness but with maximal intensity in the right iliac fossa in more advanced disease.[5],[6].
References
  1. TOLA ESRA NUR. First Trimester Spontaneous Uterine Rupture in a Young Woman with Uterine Anomaly. Case Reports in Obstetrics and Gynecology [online] 2014 December, 2014:1-3 [viewed 20 August 2014] Available from: doi:10.1155/2014/967386
  2. TAY JI, MOORE J, WALKER JJ. Ectopic pregnancy BMJ [online] 2000 Apr 1, 320(7239):916-919 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117838
  3. FIASCHETTI V, RICCI A, SCARANO AL, LIBERTO V, CITRARO D, ARDUINI S, SORRENTI G, SIMONETTI G. Hemoperitoneum from Corpus Luteal Cyst Rupture: A Practical Approach in Emergency Room Case Rep Emerg Med [online] 2014:252657 [viewed 20 August 2014] Available from: doi:10.1155/2014/252657
  4. CAVALIERE A, ERMITO S, DINATALE A, PEDATA R. Management of molar pregnancy J Prenat Med [online] 2009, 3(1):15-17 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279094
  5. WILLIAMS N, KAPILA L. Acute appendicitis in the preschool child. Arch Dis Child [online] 1991 Nov, 66(11):1270-1272 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793301
  6. GUèYE MAMOUR, MBAYE MAGATTE, NDIAYE-GUèYE MAME DIARRA, KANE-GUèYE SERIGNE MODOU, DIOUF ABDOUL AZIZ, NIANG MOUHAMADOU MANSOUR, DIAW HANNEGRET, MOREAU JEAN CHARLES. Spontaneous Uterine Rupture of an Unscarred Uterus before Labour. Case Reports in Obstetrics and Gynecology [online] 2012 December, 2012:1-3 [viewed 20 August 2014] Available from: doi:10.1155/2012/598356

Investigations - for Diagnosis

Fact Explanation
CTG Continuous fetal cardiotocography (CTG) monitoring can performed. One of the first sign of posterior uterine rupture is a pathological CTG with persistent fetal bradycardia . CTG abnormalities are associated with 55–87% of uterine ruptures. Other recognised signs of uterine rupture include loss of station of presenting part and new inefficient contractility.[3].
USS Ultrasonography is probably the safest and most useful imaging technique during pregnancy.Extra-peritoneal haematoma, intrauterine blood, free peritoneal blood, empty uterus, gestational sac above the uterus, and large uterine mass with gas bubbles have been reported as sonographic findings associated with uterine rupture.[1]. An incomplete uterine rupture can be identified by sonographic evaluation of the isthmic uterine scar in late second trimester. High frequency transducer is preferred over a low frequency one for the diagnosis of anterior uterine wall rupture. It is recommended to look for continuous myometrial band and measure its thickness, especially, if the patient complains about pain or contractions. Besides, it is highly suggested to consider the diagnosis of uterine rupture in patients who have recently undergone cesarean section.[2].
CT scan CT and magnetic resonance imaging also are used to diagnose uterine rupture. Computed tomography uses ionizing radiation and is better reserved for the evaluation of third trimester trauma and in the postpartum period. The dose of ionizing radiation during CT is less than during pelvimetry.[4].
MRI MRI also used in diagnosis of uterine rupture. Even though Magnetic resonance imaging has demonstrated its usefulness as an alternative imaging modality, its high cost, complexity, lack of portability, and availability limits its usefulness.[4].
References
  1. OGBOLE G, OGUNSEYINDE O, AKINWUNTAN A. Intrapartum Rupture of the Uterus Diagnosed by Ultrasound Afr Health Sci [online] 2008 Mar, 8(1):57-59 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408536
  2. AHMADI F, SIAHBAZI S, AKHBARI F. Incomplete Cesarean Scar Rupture J Reprod Infertil [online] 2013, 14(1):43-45 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719360
  3. NAVARATNAM K, ULAGANATHAN P, AKHTAR MA, SHARMA SD, DAVIES MG. Posterior Uterine Rupture Causing Fetal Expulsion into the Abdominal Cavity: A Rare Case of Neonatal Survival Case Rep Obstet Gynecol [online] 2011:426127 [viewed 20 August 2014] Available from: doi:10.1155/2011/426127
  4. CADET JJ. Occult uterine rupture: role of ultrasonography. J Natl Med Assoc [online] 1998 Jun, 90(6):374-376 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568237

Management - General Measures

Fact Explanation
Quick referral to a tertiary care center Uterine rupture (UR) is a serious, life-threatening emergency. A high index of suspicion and quick referral to a well equipped center may reduce the incidence of this condition. All patients with a history of cesarean section should deliver in hospitals with facilities for surgery and blood transfusion.[1].
Close monitoring Close monitoring of maternal and fetal response to uterine stimulants is mandatory to avoid complications of obstructed labour and overuse of uterine stimulants. Application of external force, vacuum forceps and breech extraction are other possible causes of UR.[1].
Emergency exploratory laparotomy and delivery Emergency exploratory laparotomy and delivery are proposed for the treatment of ruptured uterus.[1].The management of ruptured uterus is laparotomy as soon as possible, after resuscitation has been commenced. The correct surgical procedure is that which is the shortest, taking into consideration the surgeon's skill.[2]. Successful repair of dehiscence with continuation of pregnancy have been reported by researchers too.[3].
Total hysterectomy Hysterectomy whether total or subtotal was the main surgical procedure in case of UR. In circumstances where preservation of fertility is an issue to be remembered, suture repair can be considered. However, UR has a potential for mortality and cost-benefit ratio must be evaluated very well.The choice of the surgical procedure depends upon the type, location and extent of the tear as well as the patient’s condition and desire for future fertility. Total hysterectomy is the operative procedure of choice.[1].
Subtotal hysterectomy Even though total hysterectomy is the operation of choice,cardiovascular decompensation necessitates subtotal hysterectomy or simple suture repair and bilateral tubal ligation.[1].
Suture repair Consider in case of where preservation of fertility is required.Unhealthy tissue remaining after uterine repair may predispose to problems like infection, DIC, abscess formation and hemorrhage. In circumstances where suture repair is undertaken to preserve fertility, the risk of recurrent rupture is always there.[1].
References
  1. TURGUT A, OZLER A, SIDDIK EVSEN M, ENDER SOYDINC H, YAMAN GORUK N, KARACOR T, GUL T. Uterine rupture revisited: Predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey Pak J Med Sci [online] 2013, 29(3):753-757 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809304
  2. OGBOLE G, OGUNSEYINDE O, AKINWUNTAN A. Intrapartum Rupture of the Uterus Diagnosed by Ultrasound Afr Health Sci [online] 2008 Mar, 8(1):57-59 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408536
  3. AHMADI F, SIAHBAZI S, AKHBARI F. Incomplete Cesarean Scar Rupture J Reprod Infertil [online] 2013, 14(1):43-45 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719360

Management - Specific Treatments

Fact Explanation
Regular antenatal care and family planing advice Regular antenatal care and meticulous screening of high-risk patients are very important for effective prevention.Family-planning advice to reduce grandmultiparity, improved access to maternal care, decentralization of obstetric services into peripheral units to prevent home deliveries and good supervision during labor can reduce the incidence of UR.[1]
References
  1. TURGUT A, OZLER A, SIDDIK EVSEN M, ENDER SOYDINC H, YAMAN GORUK N, KARACOR T, GUL T. Uterine rupture revisited: Predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey Pak J Med Sci [online] 2013, 29(3):753-757 [viewed 20 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809304