Uterine rupture

Administration of oxytocin may result in fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the patient is receiving fluids by mouth. When used as a nasal spray, adverse reactions are rare. 

Hyperstimulation of the uterus during labor may lead to uterine Many with marked impairment of the uteroplacental blood flow, uterine rupture, cervical rupture, amniotic fluid embolism, and trauma to the infant. Overstimulation of the uterus is dangerousto both the fetusand the mother and may occur even when the drug is administered properly in a uterus that is hypersensitive to oxytocin. 

If contractions are frequent, prolonged, or excessive, die infusion is stopped to prevent fetal anoxia or trauma to die uterus. Excessive stimulation of die uterus can cause uterine hypertonicity and possible uterine rupture. The nurse places die patient on her side and provides supplemental oxygen. The effects of die drug diminish rapidly because oxytocin is short acting. 

Systematic review concludes that misoprostol shows greater efficacy versus dinoprostone, but this benefit is offset by a greater incidence of side effects.46 Compared with dinoprostone, misoprostol is associated with a higher incidence of uterine hyperstimulation, alterations in fetal heart rate, and fetal distress.46 Misoprostol also has been associated with uterine rupture in patients with previous delivery by cesarean section and should be avoided in this population.44... 

Uterine rupture has been reported when misoprostol was administered intravaginally in pregnant women to induce labor or to induce abortion beyond the first trimester of pregnancy. 

Labor and delivery - Misoprostol can induce or augment uterine contractions. A major adverse effect of the obstetrical use of misoprostol is hyperstimulation of the uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. 

Inappropriate use of oxytocin can lead to uterine rupture, anaphylactoid and other allergic reactions, and possibly maternal death. Prolonged stimulation of uterine contractions can result in the following fetal adverse reactions persistent uteroplacental insufficiency, sinus bradycardia, premature ventricular contractions, other arrhythmias, and fetal death. Prolonged use of oxytocin can lead to water intoxication secondary to the antidiuretic hormone-like effects of oxytocin. Maternal and fetal cardiovascular parameters should be monitored during oxytocin administration. 

When oxytocin is used judiciously, serious toxicity is rare. The toxicity that does occur is due either to excessive stimulation of uterine contractions or to inadvertent activation of vasopressin receptors. Excessive stimulation of uterine contractions before delivery can cause fetal distress, placental abruption, or uterine rupture. These complications can be detected early by means of standard fetal monitoring equipment. High concentrations of oxytocin with activation of vasopressin receptors can cause excessive fluid retention, or water intoxication, leading to hyponatremia, heart failure, seizures, and death. Bolus injections of oxytocin can cause hypotension. To avoid hypotension, oxytocin is administered intravenously as dilute solutions at a controlled rate. 

Contraindications to oxytocin include fetal distress, prematurity, abnormal fetal presentation, cephalopelvic disproportion, and other predispositions for uterine rupture. 

Oxytocin Activates oxytocin receptors Increased uterine contractions Induction and augmentation of labor control of uterine hemorrhage after delivery IV infusion Toxicity Fetal distress, placental abruption, uterine rupture, fluid retention, hypotension... 

Intrauterine infusion (intra-amniotic or extra-amniotic) has been reported to be associated with fewer gastrointestinal symptoms and less fever than parenteral or intra-vaginal administration (122). In intra-amniotic use, the puncture must be guided by ultrasonography, and before injection a control aspiration of some amnio tic fluid is required in order to avoid intrauterine or intravascular injection. Uterine rupture has been described with intra-amniotic treatment. 

Sawyer MM, Lipshitz J, Anderson GD, Dilts PV Jr. Third-trimester uterine rupture associated with vaginal prostaglandin E2. Am J Obstet Gynecol 1981 140(6) 710-1. 

Geirsson RT. Uterine rupture following induction of labour with prostaglandin E2 pessaries, an oxytocin infusion and epidural analgesia. J Obstet Gynecol 1981 2 76. 

Thavarasah AS, Achanna KS. Uterine rupture with the use of Cervagem (prostaglandin El) for induction of labour on account of intrauterine death. Singapore Med J 1988 29(4) 351-2. 

Maymon R, Shulman A, Pomeranz M, Holtzinger M, Haimovich L, Bahary C. Uterine rupture at term pregnancy with the use of intracervical prostaglandin E2 gel for induction of labor. Am J Obstet Gynecol 1991 165(2) 368-70. 

Azem F, Jaffa A, Lessing JB, Peyser MR. Uterine rupture with the use of a low-dose vaginal PGE2 tablet. Acta Obstet Gynecol Scand 1993 72(4) 316-7. 

Uterine rupture has been reported after intramuscular injection of carboprost to terminate a mid-trimester pregnancy (3). 

Tripathy SN. Uterine rupture following intramuscular injection of carboprost in midtrimester pregnancy termination. J Indian Med Assoc 1985 83(9) 328. 

Uterine rupture occurred after labor had been induced with dinoprostone at 10 days after term the baby was born dead (1). 

Vaginal misoprostol is more effective and better tolerated than oral misoprostol for induction of first and second trimester abortions after the administration of mifepristone (1,2). It is more effective than either gemeprost or sulprostone combined with mifepristone for induction of first trimester abortion, although uterine rupture has been reported (3). 

Several cases of uterine rupture due to misoprostol after second trimester have been reported. However, unexpectedly, administration of misoprostol for cervical ripening before surgical evacuation of a missed abortion reportedly produced uterine rupture in the first trimester... 

She had had a previous cesarean section, but it is very unlikely that that contributed, because the uterine rupture occurred at a different site to the caesarean incision (low-flap transverse section). 

Cervical laceration associated with misoprostol has been reported in a 33-year-old woman who received four doses of vaginal misoprostol (total dose 100 micrograms) for labor induction. Uterine rupture has occurred during induction of labor with misoprostol, usually in women who have had a previous cesarean section (22,23). Uterine dehiscence occurred in one and uterine rupture in three of 48 women with prior cesarean sections treated with intravaginal misoprostol 50 micrograms for cervical ripening (24). In comparison, uterine rupture occurred in one of 89 women who had an oxytocin infusion and none of 24 patients who received intravaginal alprostadil. 

Transvaginal misoprostol for induction of labor caused uterine rupture in a 26-year-old woman with a previous low transverse cesarean delivery (25). 

In two cases, uterine rupture occurred after inappropriate use (27). In one case the dose of 200 micrograms was too high. In the other case oxytocin was started 5... 

Seven pregnant women who had uterine rupture after intravaginal administration of misoprostol for induction of labor (SEDA-23, 436) had all undergone cesarean section in previous pregnancies (28). 

In the second case, there was sudden fetal bradycardia. Laparotomy showed a large clot overlying the previous uterine incision. Dissection through the hematoma showed complete separation of the uterine incision. After delivery, the uterine rupture site and a cervical laceration were successfully repaired. 

The fourth woman began to have extreme pain and fetal bradycardia then occurred. Uterine rupture from the previous incision was found at emergency cesarean section, with the baby s arm extending through the lacerated area. The uterine defect was successfully repaired. 

Uterine rupture also occurred in another three women (ages not stated) after misoprostol (dosages not stated) was used to induce labor. One underwent cesarean section because labor did not progress. During the procedure, the fetal hand and head were outside the uterine cavity (maternal and fetal outcome not stated). 

Uterine rupture has also been associated with misoprostol (200 micrograms vaginally) during second... 

Phillips K, Berry C, Mathers AM. Uterine rupture during second trimester termination of pregnancy using mifepristone and a prostaglandin. Eur J Obstet Gynecol Reprod Biol 1996 65(2) 175-6. 

Al-Hussaini TK. Uterine rupture in second trimester abortion in a grand multiparous woman. A complication of misoprostol and oxytocin. Eur J Obstet Gynecol Reprod Biol 2001 96(2) 218-9. 

Kim JO, Han JY, Choi JS, Ahn HK, Yang JH, Kang IS, Song MJ, Nava-Ocampo A A. Oral misoprostol and uterine rupture in the first trimester of pregnancy a case report. Reprod Toxicol 2005 20(4) 575-7. 

Gherman RB, McBrayer S, Browning J. Uterine rupture associated with vaginal birth after cesarean section a complication of intravaginal misoprostol Gynecol Obstet Invest 2000 50(3) 212-3. 

Hill DA, Chez RA, Quinlan J, Fuentes A, LaCombe J. Uterine rupture and dehiscence associated with intravaginal misoprostol cervical ripening. J Reprod Med 2000 45(10) 823-6. 

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