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Uterine rupture - All you need to know.

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This presentation gives the detailed information about uterine rupture - definition, epidemiology, classification, signs and symptoms, prevention and management.

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Uterine rupture - All you need to know.

  1. 1. UTERINE RUPTURE Sandeep Das 4th year MBBS Gauhati Medical College and Hospital Guwahati, Assam.
  2. 2. DEFINITION • Uterine rupture It is defined as “dissolution in the continuity of uterine wall any time after 28 weeks of gestation, with or without expulsion of the fetus.” • Uterine scar dehiscence It is defined as “separation of walls of the uterus along the line of the previous scar.”
  3. 3. INCIDENCE • 0.07/1000 births in developed countries • 0.62/1000 births in India
  4. 4. TRADITIONAL CLASSIFICATION 1. Complete rupture  All the layers of the uterus, including the peritoneum, are torn.  Uterine contents escape into the uterine cavity.  Usually results in fetal death. 2. Incomplete Rupture  Visceral peritoneum is intact.  Usually the fetus lies in the uterine cavity
  5. 5. TRADITIONAL CLASSIFICATION
  6. 6. ANATOMICAL CLASSIFICATION • Lower segment rupture • Rupture of corpus/fundus (upper segment) of uterus
  7. 7. ETIOLOGICAL CLASSIFICATION 1. Spontaneous rupture 2. Scar rupture 3. Iatrogenic (Traumatic) rupture
  8. 8. ETIOLOGICAL CLASSIFICATION (CAUSES) During pregnancy During labor Spontaneous Rupture 1. Past history of dilatation and curettage operation/manual removal of placenta 2. Grand multiparity 3. Couvelaire uterus 4. Congenital malformations of the uterus 5. Congenital fetal abnormalities 6. Morbidly adherent placenta 7. Collagen disorders 1. Obstructed labor 2. Multiparity 3. Oxytocics and prostaglandins
  9. 9. ETIOLOGICAL CLASSIFICATION (CAUSES) During pregnancy During labor Scar rupture 1. Classical caesarean (hysterotomy) scar 1. Classical caesarean (hysterotomy) scar Iatrogenic rupture 1. Injudicious and unmonitored use of oxytocics on pregnant uterus 2. Injudicious use of prostaglandins on a pregnant uterus 3. Difficult and forced external cephalic version, especially if performed under general anaesthesia 4. Abdominal blunt trauma 1. Internal podalic version and breech extraction especially in cases of obstructed labor 2. Destructive surgeries on fetus 3. Manual removal of placenta 4. Difficult or rotational forceps delivery in obstructed labor 5. Injudicious and unmonitored oxytocin infusion for acceleration of labor
  10. 10. PATHOGENESIS
  11. 11. DIAGNOSTIC TRIAD FOR UTERINE RUPTURE 1. Painful third trimester bleeding with unstable vitals 2. Loss of fetal heart sounds 3. Hot, dry vagina on vaginal examination
  12. 12. DIFFERENTIAL DIAGNOSIS 1. Abruptio placentae 2. Amniotic fluid embolism 3. Other causes of acute abdomen
  13. 13. PREVENTION 1. Early diagnosis and management of cephalo- pelvic disproportion (CPD), malpresentations and other factors leading to obstructed labor. 2. Proper selection of cases for vaginal birth after caesarean deliveries (VBAC) 3. Careful selection of cases and careful watch during oxytocin infusion either for induction or augmentation of labor and to avoid their non- judicious use, especially in multiparas 4. Avoid all uterine manipulations if the liquor has drained away.
  14. 14. PREVENTION(CONTD.) 5. Instrumental delivery should be performed only after all the pre-requisites are fulfilled and on no account should forceps be applied prior to complete cervical dilatation. 6. In cases of obstructed labor or threatened rupture, immediate caesarean delivery should be performed and all intrauterine manipulations avoided. 7. Hospital delivery for high-risk cases. 8. Forced and difficult external cephalic version especially under general anaesthesia should be avoided.
  15. 15. PREVENTION(CONTD.) 9. Undue delay in the progress of labor in a multipara with previous uneventful delivery should be taken seriously and couse should be looked into. 10. Manual removal of a morbidly adherent placenta should be performed gently and carefully by an experienced obstetrician.
  16. 16. TREATMENT • Resuscitation with adequate hydration, hemaccel and blood transfusion. • Laparotomy as a definitive treatment. The treatment modalities are- • Hysterectomy • Repair.

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