THE OVERVIEW OF UTERINE RUPTURE. group 6 OBS.pptx

UTERINE RUPTURE.

1. UTERINE RUPTURE GROUP 6

2. GROUP MEMBERS PEMPHERO MCHENGA 2405025 FAHAD GAMBULENI 2405015 SARAHUDEEN KASAKU 2405022 TRUST KANTIKI 2405046 HASSINAH MKOLOKOSA 2405032 DOREEN BANDA 2405003 GRACIE MUYWANGA 2405033

3. OBJECTIVES DEFINITION CLASSIFICATION CLINICAL FEATURES DIAGNOSIS INVESTIGATION MANAGEMENT

4. DEFINITION Uterine rupture is a tear in the wall of the uterus that involves one or more layers. This layers are Endometrium, Myometrium and Serosa. It usually occurs during labor but can happen before labor, especially in a scarred uterus. It is a life-threatening emergency for both mother and baby.  

5. Cont’’

6. Cont’' Primary uterine rupture Defined as rupture occurring in a previously intact or unscarred uterus Secondary uterine rupture May be associated with a pre existing myometrial incision, injury or anomaly

7. C LASSIFICATION OF UTERINE RAPTURE 1.BASED ON EXTENT OF THE TEAR a. Complete Uterine Rupture The tear involves all layers of the uterine wall (endometrium, myometrium, and serosa). The uterine cavity communicates with the peritoneal cavity. Commonly leads to fetal expulsion into the abdomen, severe bleeding, and maternal shock.

8. CONT b. Incomplete (Partial) Uterine Rupture The tear involves myometrium only, but serosa remains intact. The fetus remains inside the uterus, but there’s a risk of progression to complete rupture.  

9. 2. BASED ON SITE OF RUPTURE a. Lower Segment Rupture Common in previous cesarean scar or instrumental delivery. Usually less severe bleeding due to good contractility of the upper segment. b. Upper Segment (Body/Fundal) Rupture Often due to obstructed labor or misuse of oxytocics . More dangerous – involves heavy bleeding and severe maternal and fetal risk. c. Lateral or Cornual Rupture Occurs near the uterine horns; may extend into broad ligament (concealed hemorrhage).  

10. 3. BASED ON CAUSE OR ETIOLOGY a. Spontaneous Rupture Occurs without trauma, often in a WEAKNESS uterus or due to obstructed labor. b. Traumatic Rupture Caused by external trauma, instrumental delivery, Misuse of oxytocin, Manual removal of placenta, Obstructed labor or manipulation (e.g., internal podalic version).  

11. 4. BASED ON TIMING a. During Pregnancy (Antepartum rupture) – Rare; often occurs in a scarred uterus before labor begins. b. During Labor (Intrapartum rupture) – Most common; associated with obstructed or prolonged labor. c. After Delivery (Postpartum rupture) – Very rare; may follow manual removal of placenta or curettage.  

12. CLINICAL FEATURES Signs of imminent rapture Severe abdominal pain Bandl ring : given to the depression between the upper and lower halves of the uterus Seen above the umbilicus due powerful contractions of the upper uterine segment

13. Bandl ring

14. CLINICAL FEATURES contd … Signs of uterine rapture Fetal distress Severe abdominal pain Sudden pause in contractions Light –moderate vaginal bleeding Palpable fetal parts

15. Diagnostics Clinical diagnosis based on; Signs of imminent uterine rapture and uterine rapture. Supported by investigations when time allows.

16. INVESTIGATIONS Ultrasound scan (USS) this May show discontinuity of uterine wall or fetus in abdomen.  Hemoglobin and hematocrit in order to Check for blood loss.   Blood grouping and cross-match for transfusion.

17. DIFFERENTIAL DIAGNOSIS Antepartum hemorrhage Placenta abruption Placenta previa Cervical trauma Vasa previa Bloody show

18. TREATMENT CAB approach Check circulation, airway then breathing Obtain IV access and give IV fluids with large bore cannulas Draw bloods for FBC, G and X-match and bed time clotting time Oxygen 10-15L/min if available Insert foley catheter Definitive Emergency laparotomy Repair rapture, if not possible hysterectomy In case of repair counsel patient that all subsequent pregnancies are to caesarean deliveries

19. CONCLUSION Uterine rupture is a life threatening obstetric emergency that requires quick diagnosis and prompt surgical manangement.it often occurs in women with previous cesarean scars but can also result obstructed labor or misuse of uterotonic drugs. Early detection and proper antenatal and intrapartum care are vital to prevent complications and improves maternal and fetal outcome

20. REFERENCES Obstetrics & Gynecology Protocols and Guidelines, The Association of Obstetricians & Gynaecologists of Malawi, (2017). Obstetrics & Gynecology by ten teachers, 19 th edition Cunningham, F. G., Leveno, K. J., Bloom, S. L., Dashe, J. S., Hoffman, B. L., Casey, B. M., & Spong, C. Y. (2022). Williams Obstetrics (27th ed.). McGraw Hill. Shaw, R. W., Soutter, W. P., & Stanton, S. L. (2011). Gynecology (4th ed.). Elsevier Health S