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Shoulder pain is a symptom of uterine rupture

by Dec 27, 2015Uterine Rupture, VBAC5 comments

I’ve written before about the symptoms of uterine rupture as well as how having an epidural does not interfere with the diagnosis of uterine rupture. One uterine rupture symptom that some parents – and professionals – are surprised to learn about is shoulder pain.

How can an uterine rupture cause shoulder pain?
Image Source: http://wesleytodd.blogspot.com/2013/10/ablation-for-recurring-af-i.html

Image Source: http://wesleytodd.blogspot.com/2013/10/ablation-for-recurring-af-i.html

Internal bleeding from uterine rupture can cause referred pain through the phrenic nerve which can present in the shoulder.

Shoulder pain is sometimes not included in lists of uterine rupture symptoms, but I have seen it cited multiple places (see below) and have had conversations with OBs, nurses, and anesthesiologists who have experienced uterine ruptures with shoulder pain.

I’m also aware of two cases where the uterine rupture diagnosis was delayed because staff was not familiar with the incidence of referred pain.

Anyone who works with birthing women should be aware of the symptoms of uterine rupture including referred pain.

Please note that not every uterine rupture causes shoulder pain and not all shoulder pain is a symptom of uterine rupture.

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    The following quotes addressing shoulder pain & uterine rupture are from case studies and textbooks.

    “APH [brisk antepartum haemorrhage], as in this case, often indicates uterine rupture and may occur in association with shoulder tip pain due to haemoperitoneum.” (Navaratnam, 2011)

    “Management of uterine rupture depends on prompt detection and diagnosis. The classic signs (sudden tearing uterine pain, vaginal haemorrhage, cessation of uterine contractions, regression of the fetus) have been shown to be unreliable and frequently absent but any of the following should alert suspicion… Chest or shoulder tip pain and sudden shortness of breath.” (Payne, 2015)

    “Signs and symptoms of uterine rupture may include… referred pain in the shoulder (with epidural anesthesia)” (Murry, 2007 p.283)

    “Jaw, neck, or shoulder pain can be referred pain from a uterine rupture.” (Murry, 2007, p.76)

    “Shoulder pain (Kehr’s sign) is a valuable sign of intraperitoneal blood in subdiaphragmatic region. Even a small amount of blood can cause this symptom, but it is important to realize that it may be 24 h or longer after the bleeding has occurred before blood will track up under the diaphragm, and some cases of acute massive intraperitoneal bleeding may not initially have shoulder pain.” (Augustin, 2014, p. 512)

    “Shoulder tip pain may be experienced if significant haemoperitoneum is present, due to irritation of the diaphragm (i.e. referred pain through phrenic nerve).” (Baker, 2015, p.373)

     

    Resources Cited
    Augustin, G. (2014). Acute abdomen during pregnancy. Switzerland: Springer International Publishing. Retrieved from https://books.google.com/books?id=mq8pBAAAQBAJ

    Baker, P. N., McEwan, A. S., Arulkumaran, S., Datta, S. T., Mahmood, T. A., Reid, F., . . . Aiken, C. (2015). Obstetrics: Prepare for the MRCOG: Key articles from the Obstetrics, Gynaecology & Reproductive Medicine journal. Elsevier Ltd. Retrieved from https://books.google.com/books?id=DcqqCgAAQBAJ

    Murray, M. (2007). Antepartal and intrapartal fetal monitor. New York, NY: Springer Publishing Company, LLC. Retrieved from https://books.google.com/books?id=_4jYJUGG56cC

    Murray, M., & Huelsmann, G. (2008). Labor and delivery nursing: Guide to evidence-based practice. New York, NY: Springer Publishing Company. Retrieved from https://books.google.com/books?id=q22jEEZo7rwC

    Navaratnam, K., Ulaganathan, P., Akhtar, M. A., Sharma, S. D., & Davies, M. G. (2011). Posterior uterine rupture causing fetal expulsion into the abdominal cavity: A rare case of neonatal survival. Case Reports in Obstetrics and Gynecology, 2011. Retrieved from http://www.hindawi.com/journals/criog/2011/426127/

    Payne, J. (Ed.). (2015, Mar 17). Uterine rupture. Retrieved from Patient: http://patient.info/doctor/Uterine-Rupture

    What do you think?
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    5 Comments

    1. How to I get access to current articles?

      Reply
    2. I have pain in behind my shoulder the doctor sent me for a routine blood test which came back slightly anemic, the doctor has referred me to the Hospital for cameras back and front, I am 71 years old very fit BP perfect weight perfect stools perfect, could a slight bleed in my shoulder be the cause?

      Reply
      • Lots of things can cause shoulder pain. This article is talking about one cause among someone who is pregnant. Please follow up with your physician to identify the cause of your pain. I hope it resolves soon!

        Reply
    3. Do you when the shoulder pain begins? I am 19 weeks and I have been having shoulder pains could this be a sign I shouldn’t vba3c or is this normal to have shoulder pain.

      Reply
      • Hi Kurvy!

        If you have concern over any pain you are experiencing, I encourage you to contact your doctor or midwife.

        Best,

        Jen

        Reply

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    Jen Kamel

    As an internationally recognized consumer advocate and Founder of VBAC Facts®, Jen helps perinatal professionals, and cesarean parents, achieve clarity on vaginal birth after cesarean (VBAC) through her educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. She speaks at conferences across the US, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. She envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support, so they can plan the birth of their choosing in the setting they desire.

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