WordNet

state of being torn or burst open
the act of making a sudden noisy break
a personal or social separation (as between opposing factions); "they hoped to avoid a break in relations" (同)breach, break, severance, rift, falling out
of or involving the uterus; "uterine cancer"

PrepTutorEJDIC

〈U〉〈C〉(…の)破裂《+『of』+『名』》 / 〈U〉〈C〉(友好的関係などの)決裂,仲たがい / 〈C〉裂け目 / 〈C〉脱腸,ヘルニア / …‘を'破裂させる / 〈友好関係など〉‘を'断ち切る / 破裂する
子宮の / 同母異父の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/08 13:24:07」(JST)

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Uterine rupture is a potentially catastrophic event during childbirth by which the integrity of the myometrial wall is breached. In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament. A uterine rupture is a life-threatening event for mother and baby.

A uterine rupture typically occurs during active labor, but may already develop during late pregnancy.

Uterine dehiscence is a similar condition, but involves fewer layers, less bleeding, and less risk.^[1]

Risk factors and causes

A uterine scar from a previous cesarean section is the most common risk factor. (In one review, 52% had previous cesarean scars.)^[2] Other forms of uterine surgery that result in full-thickness incisions (such as a myomectomy), dysfunctional labor, labor augmentation by oxytocin or prostaglandins, and high parity may also set the stage for uterine rupture. In 2006, an extremely rare case of uterine rupture in a first pregnancy with no risk factors was reported.^[3]

Presentation

Symptoms of a rupture may be initially quite subtle. An old cesarean scar may undergo dehiscence; but with further labor the woman may experience abdominal pain and vaginal bleeding, though these signs are difficult to distinguish from normal labor. Often a deterioration of the fetal heart rate is a leading sign, but the cardinal sign of uterine rupture is loss of fetal station on manual vaginal exam. Intra-abdominal bleeding can lead to hypovolemic shock and death. Although the associated maternal mortality is now less than one percent, the fetal mortality rate is between two and six percent when rupture occurs in the hospital.

In pregnancy uterine rupture may cause a viable abdominal pregnancy. This is what accounts for most abdominal pregnancy births.

Treatment

Emergency exploratory laparotomy with cesarean delivery accompanied by fluid and blood transfusion are indicated for the management of uterine rupture. Depending on the nature of the rupture and the condition of the patient, the uterus may be either repaired or removed (cesarean hysterectomy). Delay in management places both mother and child at significant risk.

Signs and symptoms

Abdominal pain and tenderness. The pain may not be severe; it may occur suddenly at the peak of a contraction. The woman may describe a feeling that something "gave way" or "ripped."
Chest pain, pain between the scapulae, or pain on inspiration—Pain occurs because of the irritation of blood below the woman's diphragm
Hypovolemic shock caused by hemorrhage—Falling blood pressure, tachycardia, tachypnea, pallor, cool and clammy skin, and anxiety. The fall in blood pressure is often a late sign of hemorrhage
Signs associated with fetal oxygenation, such as late decelerations, reduced variability, tachycardia, and bradycardia
Absent fetal heart sounds with a large disruption of the placenta; absent fetal heart activity by ultrasound examination
Cessation of uterine contractions
Palpation of the fetus outside the uterus (usually occurs only with a large, complete rupture). The fetus is likely to be dead at this point.
Signs of an abdominal pregnancy

References

^ "Uterine Rupture in Pregnancy: eMedicine Obstetrics and Gynecology". Retrieved 2010-03-23.
^ Chibber R, El-Saleh E, Fadhli RA, Jassar WA, Harmi JA (March 2010). "Uterine rupture and subsequent pregnancy outcome - how safe is it? A 25-year study". J Matern Fetal Neonatal Med 23 (5): 421–4. doi:10.3109/14767050903440489. PMID 20230321.
^ Walsh CA, O'Sullivan RJ, Foley ME (2006). "Unexplained prelabor uterine rupture in a term primigravida". Obstetrics and gynecology 108 (3 Pt 2): 725–7. doi:10.1097/01.AOG.0000195065.38149.11. PMID 17018479.

UpToDate Contents

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1. 帝王切開後の子宮離開および子宮破裂 uterine dehiscence and rupture after previous cesarean delivery
2. 無傷子宮における破裂 rupture of the unscarred uterus
3. 妊娠中の女性および産後の女性における腹痛および急性腹症に対するアプローチ approach to abdominal pain and the acute abdomen in pregnant and postpartum women
4. 帝王切開出産後の分娩経路の選択 choosing the route of delivery after cesarean birth
5. 妊娠性絨毛腫瘍：疫学、臨床的特徴、診断、病期分類、およびリスク層別化 gestational trophoblastic neoplasia epidemiology clinical features diagnosis staging and risk stratification

English Journal

Maternal and neonatal outcomes of grand multiparas over two decades in Mali.

Teguete I, Maiga AW, Leppert PC.SourceGabriel Touré Teaching Hospital, Department of Obstetrics and Gynecology, Bamako, Mali Duke University School of Medicine, Durham, NC, USA Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA.
Acta obstetricia et gynecologica Scandinavica.Acta Obstet Gynecol Scand.2012 May;91(5):580-6. doi: 10.1111/j.1600-0412.2012.01372.x.
Objective. To analyze the association between grand multiparity and maternal and neonatal morbidity and mortality. Design. Retrospective cross-sectional study. Setting. Point G National Hospital, a tertiary care hospital in Bamako, Mali. Population. All singleton births from 1985 to 2003. Methods. C
PMID 22313177

Gene expression patterns of the Bcl-2 and bax genes in preterm birth.

Demendi C, Börzsönyi B, Végh V, Nagy ZB, Rigó J Jr, Pajor A, Joó JG.SourceSecond Department of Gynecology and Obstetrics, Semmelweis University NAGY GÉN Diagnostics and Reasearch Ltd. First Department of Gynecology and Obstetrics, Semmelweis University, Budapest, Hungary.
Acta obstetricia et gynecologica Scandinavica.Acta Obstet Gynecol Scand.2012 Apr 24. doi: 10.1111/j.1600-0412.2012.01428.x. [Epub ahead of print]
Objective. The apoptotic genes Bax and Bcl-2 are both involved in the pathogenesis of preterm delivery in conjunction with additional factors. We characterized gene expression patterns of these apoptotic regulatory genes as well as relevant environmental factors. Design. A gene expression study with
PMID 22524261

Japanese Journal

分娩誘発・陣痛促進:「子宮収縮薬による陣痛誘発・陣痛促進に際しての留意点:改訂2011年版」のポイント(<特集>分娩誘発・陣痛促進)

水上尚典
日本産科婦人科學會雜誌 63(7), 1385-1388, 2011-07-01
NAID 110008686965

Distinctive ultrasonographic finding of complete uterine rupture in early mid-trimester

OGAWA Masaki,SUGAWARA Tae,SATO Akira,TANAKA Toshinobu
Journal of medical ultrasonics : official journal of the Japan Society of Ultrasonics in Medicine 38(2), 93-95, 2011-04-15
NAID 10029031300