The document discusses several types of obstetric injuries that can occur including ruptured uterus, cervical tears, and perineal tears. It provides details on the causes, risk factors, clinical presentation, diagnosis, and treatment for each type of injury. Ruptured uterus is more common with high parity and previous c-sections. It can occur during pregnancy or labor from spontaneous causes or trauma. Cervical tears are often caused by instrumental deliveries or rapid cervical dilation and can lead to bleeding or incompetence. Perineal tears degree is based on the extent of tearing and is usually due to overstretching of the perineum from issues like malposition or a large baby. Proper repair and care is important to

1. B Y
M A G D Y A B D E L R A H M A N M O H A M E D
2 0 1 5
OBSTETRIC INJURIES

2. Rupture uterus.
Cervical & vaginal tears.
Perineal injuries.

3. RUPTURE UTERUS
 More common with high parity. Why??

4. Etiology
I-Rupture during pregnancy.
Spontaneous
Uterine scar ( most common).
Rudementary horn at 4th or 5th m.
Incarcerated RVF.
External trauma.

5. Cont.
II- Rupture during labour.
 Spontaneous
 Obstructed labour.
 Uterine scar.
 Traumatic
 Forceps.
 Internal podalic version.
 Destructive operations (historical).

7. Types of rupture
 Complete.
 Dehiscent scar.

8. Predisposing factor for scar weakness
 Site: upper segment.
 Bad coaptation of edge.
 Poor hemostasis.
 Infection.
 short pregnancy interval after CS.

9. Clinical picture
 History of prolonged labuor.
 Picture of obstructed labour.
 Vital signs
 Abdominal examination.
 Easily felt fetal part
 Uterus felt away from fetus
 Vaginal bleeding
 Dehiscent scar ??

10. Diagnosis
 C/P
 U/S
Fetal bradycardia or death.
Fetus away from uterus.

11. Differential diagnosis
 Concealed accidental Hge.
 Advanced abdominal pregnancy.

12. Prevention
 Early diagnosis of obstructed labour.
 Proper use of ecbolics.
 Careful intrauterine manipulation.

13. Treatment
 Resuscitation.
 Exploration.
 Repair site of rupture if possible.
 Check integrity of the bladder ….. Repair
any tear.
 Hysterectomy is life saving in some
situations.

14. CERVICAL TEARS
 Predisposing factors.
Instrumental deliveries.
Rapid dilatation of cervix.
Scarring of cervix.

15. Complications
 Post partum Hge.
 Upward extension to lower uterine segment.
 Cervical incompetence. (delayed)

16. Diagnosis
 Examination under anaesthesia.
 Hold ant & post lips by ring forceps.

17. Treatment
 Correction of general condition.
 Immediate repair.
 You should reach the apex of tear.

19. PERINEAL TEARS
Degree.
 1st degree
 2nd degree
 3rd degree
 4th degree

20. Etiology
 Overstretch of perineum
 Malposition
 Extention of head before crowning.
 Large head
 Narow subpubic angle
 Forceps.
 Rapid stretch of perineum
 Precipitate labour
 Rigid or scared perineum
 Iatrogenic.

21. Complication
 Bleeding.
 Infection.
 Delayed.
Anal incontinence.
Rectovaginal fistula.

22. Treatment
 Anatomical repair under anaesthesia
 Preferred within 24 hour.
 Aftercare:
 In case of 4th degree
 3 days nothing per mouth then 3 days oral fluid.