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ANTEPARTUM UTERINE RUPTURE: A LITERATURE REVIEW
Shamsieva Dilnoza Alisherovna
Academic degree: PhD candidate
https://doi.org/10.5281/zenodo.17311095
Introduction.
Antepartum uterine rupture is a rare but life-threatening obstetric
emergency that occurs before the onset of labor. Unlike intrapartum rupture, it develops
spontaneously and is most often associated with uterine scarring following previous surgical
procedures such as cesarean section, myomectomy, or reconstructive surgery. The reported
incidence varies from 1 in 5,000 to 1 in 20,000 pregnancies and is rising due to the global
increase in cesarean deliveries. Despite its rarity, antepartum rupture remains a significant cause
of maternal and perinatal morbidity and mortality, especially in low-resource settings.
Methods.
This literature review was based on a synthesis of international and regional
publications indexed in PubMed, Scopus, and eLibrary databases between 2000 and 2024. The
search included terms “antepartum uterine rupture,” “uterine scar dehiscence,” “cesarean section
complications,” and “maternal outcomes.” Studies describing pathogenesis, diagnostic
approaches, clinical presentation, and management strategies were analyzed. Priority was given
to systematic reviews, case series, and clinical guidelines from the World Health Organization
and professional obstetric associations.
Results and Discussion.
The main etiological factors identified include scar dehiscence
due to inadequate healing, myometrial thinning at the site of previous incision, and abnormal
placentation (placenta accreta spectrum). Less common causes involve uterine malformations,
trauma, and excessive uterine distension in multiple pregnancies or polyhydramnios. Clinical
manifestations are often nonspecific—abdominal pain, fetal distress, peritoneal irritation, or
cessation of fetal movements. Imaging methods such as ultrasound and MRI play a critical role
in early diagnosis. Emergency laparotomy remains the cornerstone of management, with uterine
repair or hysterectomy depending on the extent of rupture and the patient's reproductive plans.
Conclusions.
Antepartum uterine rupture, though rare, carries a high risk of maternal and
fetal death. Early recognition, risk assessment in women with uterine scars, and multidisciplinary
management are essential for improving outcomes. Developing standardized diagnostic
algorithms and surveillance protocols for high-risk pregnancies remains a global priority.
Keywords:
Antepartum uterine rupture; cesarean scar; placenta accreta; uterine
dehiscence; maternal morbidity; obstetric emergency.
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