inspiration—Pain occurs because of the irritation of blood below the woman's diaphragm Hypovolemic shock caused by bleeding, evidenced by falling blood pressure, tachycardia, tachypnea, pallor, cool and clammy skin, and anxiety. The fall in blood pressure is often a late sign of haemorrhage Signs associated with fetal oxygenation, such as late deceleration, 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 Post-term pregnancy Risk factors A uterine scar from a previous cesarean section is the most common risk factor. (In one review, 52% had previous cesarean scars.) 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. Uterine rupture during pregnancy without a prior cesarean section is one of the major diagnostic criterion for vascular Ehlers-Danlos syndrome (vEDS). Mechanism In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus spill into the peritoneal cavity or the broad ligament. 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. See also Uterine perforation References External links Medical emergencies Complications of labour and delivery Acute pain Wikipedia medicine articles ready to translate