Obstetrics emergency ruptured uterus.ppt

Obstetrics emergency ( rupture uterus)
4 th bsc nursing

1. RUPTURE OF THE UTERUS

3. DEFINITION
Dissolution of the continuity of the uterine
wall any time beyond 28 weeks of
pregnancy is called rupture of uterus

4. INCIDENCE
1 in 2000 to 1 in 200

5. ETIOLOGY
SPONTANEOUS
DURING PREGNANCY (Complete & upper segment)
•Previous damage
•Grand multiparae
•Congenital malformation of the uterus-Bicornuate uterus
•Abruptio placentae
DURING LABOUR
•Obstructive rupture(Lower segment through lateral side to
the upper segment)
•Non – obstructive rupture – Grand multiparae(Fundal area and
complete)

6. Contd….
SCAR RUPTURE
Caesarean section scar
Myomectomy or uteroculoplasty
IATROGENIC
DURING PREGNANCY
•Injudicious administration of oxytocin
•Use of prostaglandins for induction of abortion or labour
•Forcible external version under GA
•Fall or blow on the abdomen
DURING LABOUR
•Internal podalic version
•Destructive operation
•Manual removal of the placenta
•Application of forceps through incompletely dialated cervix
•Injudicious administration of oxytocin for augmentation of labour

7. TYPES
Depending on whether peritoneal coat is involved or
not
Incomplete peritoneum remains intact
Incomplete rupture occur in the lower segment
Complete rupture occur following disruption of scar
in the upper segment

8. DIAGNOSIS
DURING PREGNANCY
SCAR RUPTURE : Classical or hysterotomy
Dull abdominal pain over the scar area with slight vaginal
bleeding
Tenderness on uterine palpation
FHS may be absent
A sense of something is giving way accompanied by acute
abdominal pain and collapse

9. Contd….
SPONTANEOUS RUPTURE IN UNINJURED UTERUS
Acute pain with fainting attacks and may collapse
Features of shock
Acute tenderness on abdominal examination
Palpation of superficial fetal parts if rupture is
complete
Absence of fetal heart rate

10. Contd…
RUPTURE FOLLOWING FALL, BLOW OR
EXTERNAL VERSION OR USE OF OXYTOCICS
Acute pain abdomen
Slight vaginal bleeding
Rapid pulse
Tender uterus

11. Contd…
DURING LABOUR
SCAR RUPTURE
Same as during pregnancy
SPONTANEOUS OBSTRUCTIVE RUPTURE
Signs of obstruction
Pain becomes severe in an attempt to overcome obstruction
Pain becomes sever at the supra pubic region
Dehydrated and exhausted
SPONTANEOUS NON OBSTRUCTIVE RUPTURE
Agonising bruising pain ,relief with cessation of contraction
Shock, internal haemorrhage, tenderness and vaginal bleeding
RUPTURE FOLLOWING MANIPULATIVE OR INSTRUMENTAL
DELIVERY
Sudden deterioration of general condition
Shortening of the cord following difficult vaginal delivery

12. PROPHYLAXIS
1.At risk mothers should deliver in the hospital
2.General anesthesia should not be used in version
3.Find out the cause for undue delay in labour in multiparae
4.Judicious selection of cases with previous LSCS for vaginal
delivery
5.Careful watch of patients receiving oxytocin and avoid IM
oxytocin
6.Internal podalic version should not be done in obstructed labour
7.Avoid forceps delivery or breech extraction in incompletely
dialated cervix
8.Destructive operation should be done by an expert
9.Attempt to remove placenta accreta should be avoided

13. TREATMENT
RESUCITATION
LAPAROTOMY
Hysterectomy
Repair
Repair and sterilisation