rupture-of-the-uterus.ppt

Uterine rupture for nursing students
OBG 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

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

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