title: Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery.
abstract: OBJECTIVE
  Uterine rupture is a rare but potentially catastrophic complication of pregnancy that requires rapid diagnosis. Classically, its signs and symptoms combine pain, fetal heart rate (FHR) abnormalities, and vaginal bleeding. The purpose of this study is to identify these signs and symptoms as well as the immediate complications of complete and incomplete (partial) ruptures of the uterine wall, whether or not they follow a previous cesarean delivery.
  
  
  METHODS
  Retrospective study of case records from two university hospital maternity units, from 1987 to 2008.
  
  
  RESULTS
  In a total of 97,028 births during the study period, we identified 52 uterine ruptures (0.05%): 25 complete and 27 partial. Most (89%) occurred in women with a previous cesarean delivery. In complete ruptures, FHR abnormalities were the most frequent sign (82%), while the complete triad of FHR abnormalities-pain-vaginal bleeding was present in only 9%. The signs and symptoms of partial ruptures were very different; these were asymptomatic in half the cases (48%). Neonatal mortality reached 13.6% among the complete ruptures; 27 and 40% of these newborns had pH<6.80 and pH<7.0, respectively. Among the incomplete ruptures, only 7.7% of the newborns had a pH<7.0 and there were no deaths.
  
  
  CONCLUSIONS
  Although complete rupture of the uterus has a severe neonatal prognosis, the complete set of standard symptoms is present in less than 10% of cases. FHR abnormalities are by far the most frequent sign.
authors: Pôle Femme Mère Nouveau-né et Pôle d'Anesthésie-Réanimation, Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, Lille Cedex 59037, France. Electronic address: marieguiliano@gmail.com.
authors: M
authors: M
authors: Guiliano
authors: Pôle Femme Mère Nouveau-né et Pôle d'Anesthésie-Réanimation, Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, Lille Cedex 59037, France.
authors: E
authors: E
authors: Closset
authors: Pavillon Paul Gellé, Centre Hospitalier de Roubaix, 91 avenue J Lagache, Roubaix 59100, France.
authors: D
authors: D
authors: Therby
authors: Pavillon Paul Gellé, Centre Hospitalier de Roubaix, 91 avenue J Lagache, Roubaix 59100, France.
authors: F
authors: F
authors: LeGoueff
authors: Pôle Femme Mère Nouveau-né et Pôle d'Anesthésie-Réanimation, Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, Lille Cedex 59037, France; EA 4489, Faculté de Médecine Henri Warembourg, Université Lille 2, UPRES Lille Nord de France, Lille, France.
authors: P
authors: P
authors: Deruelle
authors: Pôle Femme Mère Nouveau-né et Pôle d'Anesthésie-Réanimation, Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, Lille Cedex 59037, France; EA2694, UDSL, Université Lille Nord de France, UHC Lille, Lille F-59000, France.
authors: D
authors: D
authors: Subtil
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014597:Uterine Rupture / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000401:mortality
keywords: Fetal heart rate abnormalities; Neonatal acidosis; Neonatal asphyxia; Trial of labor after cesarean (TOLAC); Uterine rupture