From the Research
Management of early rupture of the uterus in an intrauterine pregnancy requires immediate surgical intervention, as evidenced by the most recent study 1, which highlights the importance of prompt recognition and treatment to minimize maternal and fetal morbidity and mortality. The patient should be rushed to the operating room for an emergency laparotomy to control hemorrhage and repair the uterine defect. Initial stabilization includes:
- Establishing large-bore IV access (two 16-18 gauge lines)
- Aggressive fluid resuscitation with crystalloids and blood products (packed red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio)
- Continuous monitoring of vital signs Oxygen supplementation should be provided to maintain maternal oxygenation. The surgical approach typically involves a midline vertical incision for optimal exposure. The surgeon will evacuate hemoperitoneum, deliver the fetus and placenta if still in the uterine cavity, and then either repair the uterine defect with a two-layer closure using absorbable sutures or perform a hysterectomy if hemostasis cannot be achieved or the damage is too extensive. Broad-spectrum antibiotics (such as cefazolin 2g IV or ampicillin-sulbactam 3g IV) should be administered, as supported by previous studies 2, 3. Postoperatively, close monitoring in an intensive care setting is necessary with ongoing assessment of hemodynamic status, urine output, and laboratory parameters. Uterine rupture is a life-threatening obstetric emergency with high maternal and fetal mortality rates due to catastrophic hemorrhage and requires a multidisciplinary approach involving obstetricians, anesthesiologists, neonatologists, and critical care specialists, as emphasized in the literature 4, 5. The most recent study 1 provides valuable insights into the management of uterine rupture, highlighting the importance of prompt surgical intervention and the possibility of primary uterine repair in more than two-thirds of cases. Key considerations in the management of early uterine rupture include:
- Prompt recognition and diagnosis
- Immediate surgical intervention
- Aggressive fluid resuscitation and blood product administration
- Broad-spectrum antibiotic coverage
- Multidisciplinary approach to care
- Close monitoring in an intensive care setting postoperatively.