Epidural analgesia and uterine rupture during labour

Uterine rupture and scar dehiscence. A five-year survey

A review of the medical records from two public hospitals in Sydney was undertaken to determine the incidence of this uncommon complication. Twenty-seven cases of uterine rupture were reported out of 31,115 deliveries with an incidence of 0.086% (versus 0.05% in the current literature). The incidence associated with previous caesarean section was 0.038% (versus 0.8% in the current literature). Predisposing and associated factors in this review were similar to those reported by others. There was no maternal mortality in our series but the fetal mortality rate was 5 out of 27 cases. Uterine ruptures in the midtrimester were associated with high rates of maternal morbidity and fetal loss. Forty-eight per cent of patients with uterine rupture received epidural analgesia. The associated factors and outcomes are discussed. The current literature is reviewed in relation to this high-risk group of patients.

Uterine rupture during labour in a primigravida

Uterine rupture is extremely rare in the absence of any of the commonly recognized risk factors. We describe here a case of incomplete uterine rupture in a woman in her first pregnancy who had no previous instrumentation to the genital tract. Her only significant history was that of 2 episodes of minor antepartum haemorrhage occurring prior to induction of labour with artificial rupture of membranes and intravenous oxytocin. The rupture was manifested by 450 mL blood in the peritoneal cavity when an emergency Caesarean section was performed for persistent fetal bradycardia.

Epidural opioids and previous caesarean section

In the following case there was delay in diagnosing uterine rupture in a patient with an epidural in situ. The danger of using large doses of local anaesthetics and opioids epidurally in patients who have had previous caesarean sections is discussed.