Uterus rupture and uterus cervix rupture

obstetric

1. Uterus rupture and uterus cervix rupture MNUMS Ambaselmaa.B

2. Uterus rupture classification Uterus intant rupture Uterus intant rupture Uterus scar rupture

3. And also uterus dehiscence Uterus rupture

4. During labour After delivery

5. Circumstances in which uterine rupture occurs – After prolonged labour , especially with dystocia in primiparas . – Grand multiparas (more than 6 deliveries). – When excessive amounts of uterotonic (oxytocin or misoprostol) are used. – Prior history of uterine surgery: caesarean section, especially classical ,uterine perforation; myomectomy.

6. Impending rupture • Maternal agitation • Increasingly severe abdominal pain that persists between contractions • Bandl’s ring -a sign of obstructed labour . At first glance the Bandl’s ring may look like a distended bladder.

7. Rupture: • Shoulder-tip pain or increased pain on inspiration, a sign of haemoperitoneum . Sometimes the pain is sudden, during a contraction.The pain may be less obvious in cases of posterior uterine rupture. •  Hypovolaemic shock due to bleeding (rapid or weak or unmeasurable pulse, very low or undetectable blood pressure, tachypnoea , cold sensation, damp skin, agitation or anxiety). • Contractions stop. • Slow foetal heart rate or no heart tone. • Sometimes feels like foetus can be palpated just below the skin if large, complete rupture. Foetus is usually dead.

8. There are 3 degrees of cervical lacerations First degree lacerations - Length of cervical rupture not over 2cm 2. Second degree lacerations - Length of rupture >2cm but does not extend to vaginal fornices 3. Third degree lacerations - Ruptured area extends to the vaginal fornices - If extends to vaginal fornices : very dangerous

9. Cervical laceration - Rigidity of cervix - Abnormal structure due to scarring from previous surgery - Rapid delivery of head in breech presentation

10. So DDx Anamnesis Symptoms Examine of fetus Then check uterus cervical after birth

11. DDx Uterus rupture Uterus scar rupture Cervical rupture 3rt degree Anamnesis After prolonged labour , dystocia in primiparas,grand multiparas, excessive amounts of uterotonic Prior history of uterine surgery Symptom Impending rupture symptoms Internal bleeding Impending rupture symptoms Internal bleeding Internal bleeding can occur Bleeding examine Bandl’s ring, increasingly severe abdominal pain that persists between contractions then abdominal get worse Bandl’s ring, increasingly severe abdominal pain that persists between contractions then abdominal get worse Vaginal bleeding Check uterus cervix

12. https://medicalguidelines.msf.org/viewport/EONC/english/3-3-uterine-rupture-19726631.html IqraYasin5:”complications-of-labor”(slide share) Mkhadhari :”birth-canal-trauma-and-uterus-rupture” ”(slide share)