From the Guidelines
Uterine rupture in a non-pregnant woman is extremely rare and difficult to diagnose on ultrasound alone, and if suspected, immediate surgical evaluation is necessary as this represents a medical emergency. The diagnosis of uterine rupture on ultrasound may be challenging, and findings such as discontinuity of the uterine wall, hemoperitoneum (free fluid in the abdomen), or an abnormal uterine contour may be indicative of this condition 1. However, CT scan or MRI typically provides better visualization of uterine rupture. In non-pregnant women, uterine rupture is most commonly associated with previous uterine surgery (particularly cesarean sections), trauma, or invasive gynecological procedures.
Some key points to consider in the diagnosis and management of uterine rupture in non-pregnant women include:
- The use of ultrasound, including US duplex Doppler pelvis, US pelvis transvaginal, and US pelvis transabdominal, as initial imaging modalities for abnormal uterine bleeding, which may be complementary in providing unique clinical information 1
- The potential benefits and limitations of US sonohysterography, which may be controversial but could be considered in certain clinical scenarios
- The importance of a high index of suspicion for uterine rupture, given the nonspecific clinical presentation with abdominal pain, vaginal bleeding, and signs of hypovolemic shock
- The need for emergency laparotomy for surgical repair or hysterectomy, depending on the extent of damage and the patient's hemodynamic stability, as well as the potential requirement for blood transfusions and post-operative monitoring in an intensive care setting with antibiotics to prevent infection.
From the Research
Uterine Rupture in Non-Pregnant Women
- Uterine rupture is a rare but potentially catastrophic event that can occur in both pregnant and non-pregnant women 2, 3, 4.
- The risk factors for uterine rupture include previous uterine surgery, such as cesarean delivery or myomectomy, and abdominal trauma 2, 4.
- Clinical diagnosis of uterine rupture can be difficult, and diagnostic imaging plays a crucial role in diagnosis 3, 5.
- Ultrasound is the initial imaging modality of choice for evaluating suspected uterine rupture, but other imaging modalities such as computed tomography and magnetic resonance imaging may also be used 5.
Imaging Evaluation of Uterine Rupture
- Ultrasound can depict secondary signs associated with uterine wall injury and occasionally reveal the site of perforation 5.
- Computed tomography can be used to complement ultrasound findings and provide a more comprehensive picture 5.
- Magnetic resonance imaging can be an important problem-solving tool in certain scenarios, particularly in evaluating the extent of uterine injury 3, 5.
Clinical Presentation and Complications
- Uterine rupture can present with minor symptoms, such as abdominal pain and vaginal bleeding, but can quickly progress to a life-threatening emergency 2, 6.
- The complications of uterine rupture include maternal mortality, peripartum hysterectomy, and perinatal mortality and morbidity 2, 6, 4.
- Prompt diagnosis and treatment are essential in limiting morbidity and mortality associated with uterine rupture 3, 6, 4.