Rupture of uterus

rupture of uterus

1. RUPTURE OF UTERUS

2. SCAR RUPTURE DURING PREGNENCY : Incidence of classical c/s is 5-10 times higher than lscs Weak scar after previous operations on the uters History of c/s (VBAC- VAGINAL BIRTH AFTER C/S) Myomectomy Excision of uterine septum Previous perforation of uterus(D&C, hysteroscopy, forceps delivery)

3. CLASSIFICATIONS Complete rupture : - usually occurs in the disruption of scar in the upper segment, involves the entire length of scar It may also spontaneous rupture. The fetus with or without placenta escapes out of uterus. Uterus remains contracted. Incomplete rupture: Results from lower segment scar or extension of cervical tear. Due to scar dehiscnce . Both fetus and placenta remain inside the uterus

4. CLASSIFICATION BY LOCATION UPPER SEGMENT: -Spontaneous non obstructive rupture Involves fundus LOWER SEGMENT Obstructive type rupture occurs It involves anterior lower segment and extends upto lateral wall

5. DIAGNOSIS During pregnency : In case of scar rupture : the patient complaints dull pain over the scar with slight vaginal bleeding. Fhs may be irregular or absent Diagnosis is self evident. In case of spontaneous ruptre : usually occur in grand multi parous woman

6. Contd., Acute pain in abdomen Fainting and sometimes patient may collapse Features of shock may seen On abdominal examination palpation of fetal parts superficially Absence of FHS Iatrogenic : Occurs in case of fall, blow or external version or use of oxytocics . Features are Rapid pulse

7. Contd., Tender uterus Confirmation is done by laprotomy DURING LABOR In case of scar rupture Classical scar : features are same those occurs during pregnency LSCS scar : the onset is incidious with no signs hence it is called silent rupture.

8. Contd., SPONTANEOUS OBSTRUCTIVE RUPTURE : There are 2 phases : Premonitory phase & Phase of rupture Premonitory phase : usually seen multipara The features are : Pain become severe at quick intervals at suprapubic region Pulse rate and temperature raises Bandl’s ring is visible FHS may absent Presenting part found obstructed in the pelvis Vagina becomes dry and oedematous

9. Contd., Phase of rupture : Pain will be dull and aching Absence of uterine contracion Features of exhaution and shock is seen Superficial fetal parts Absence of fhs Varying degrees of bleeding present