Practical Guide to Simulation in Delivery Room Emergencies

Uterine rupture during pregnancy is a rare but life- threatening obstetric complication, comparable to a clinical catastrophe that leads to high maternal and perinatal morbidity and mor- tality [1]. The initial symptoms and signs of uterine rupture can be typically nonspecific, and they can lead to a difficult diagno- sis, sometimes delaying the definitive surgical therapy. Generally, from the time of diagnosis to delivery, only 10–37 min are available before clinically significant fetal morbidity becomes inevitable. Fetal morbidity occurs as a result of catastrophic uteroplacental hemorrhage, with fetal anoxia, or a combination of both events [2]. Uterine rupture classification can be divided into two main categories: rupture in a scarred uterus and rupture in an intact uterus. The term “scarred uterus” is referred to the uterus of a woman that was previously surgically treated. The cesarean section (CS) is the principal operation succes- sively involved in overall uterine ruptures. Nevertheless, a uterine rupture in pregnancy is further divided into “spontaneous” or “traumatic” ruptures. Most authors, using the term “spontaneous uterine rupture,” mean that the uterine rupture occurred during labor, with no other concomitant trauma [3]. Spontaneous uterine rupture, as well as a very rare event, is also an unpredictable event, requiring much clinical insight and a high suspicion for clinical diagnosis [4]. Generally, vigorous and sustained myometrial contrac- tions occurring during labor for a prolonged period can result in clinical dehiscence of the uterine wall and then a complete rupture. Thus, the term intrapartum “spontaneous” uterine rupture is misleading. Generally, additional factors are almost always present when a gravid uterus ruptures, even if very rare cases of uter- ine rupture in non-laboring, nulliparous pregnant, with an unscarred uterus, have been reported [5]. Uterine rupture may be incomplete, when uterine serosa remains intact, or complete, in cases of disruption of the full th