Rupture of the uterus.pptx

uterine rupture

1. Rupture of the uterus

2. DEFINITION   Disruption i n the continuity of the uterine wall (endometrium, myometrium and serosa) any time beyond 28 weeks of pregnancy is called rupture of uterus

3. INCIDENCE The prevalence widely varies from 1 in 2000 to 1 in 200

4. ETIOLOGY The causes of rupture of the uterus are broadly divided into: Spontaneous rupture Scar rupture Iatrogenic rupture

5. SPONTANEOUS – DURING PREGNANCY (Complete & upper segment ) Previous damage Grand multiparae Congenital malformation of the uterus- Bicornuate uterus Couvelair uterus

6. DURING LABOUR Obstructive rupture- The rupture involves the lower segment extends through one lateral side of the uterus to the upper segment Non – obstructive rupture – Grand multiparae . Weakening of the walls due to repeated previous births may be the responsible factors. The rupture usually involves the fundal area and is complete

7. Contd …. SCAR RUPTURE Caesarean section scar Myomectomy DURING PREGNANCY Classical cesarean scar Lower segment scar rarely ruptures during pregnancy DURING LABOR The corneal resection for ectopic pregnancy is more vulnerable to rupture during labor . Rare lower segment scar predominantly ruptures during labor

8. IATROGENIC OR TRAUMATIC 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

9. TYPES Depending on whether peritoneal coat is involved or not INCOMPLETE RUPTURE- Incomplete peritoneum remains intact. Incomplete rupture occur in the lower segment COMPLETE RUPTURE- Complete rupture occur following disruption of scar in the upper segment

10. 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

11. 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

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

13. 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

14. 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

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

16. TREATMENT RESUCITATION LAPAROTOMY Hysterectomy Repair Repair and sterilisation