Rupture of the uterus.pptx
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Rupture of the uterus can occur spontaneously, due to scarring from previous procedures like cesarean sections or myomectomies, or due to trauma. It is a disruption of the uterine wall that can occur during pregnancy or labor. Risk factors include grand multiparity, previous uterine damage, and certain congenital uterine anomalies. Diagnosis involves abdominal pain and tenderness along with signs of shock. Treatment requires resuscitation and laparotomy, which may involve hysterectomy, repairing the rupture, or repair with sterilization. Preventive measures include careful monitoring of at-risk mothers and judicious use of oxytocics or instruments during delivery.
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Obstructed labour
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Abnormal uterine action
The document discusses uterine contractions during labor and delivery. It defines the normal frequency and intensity of contractions. It describes two pacemakers in the uterus that generate contractions and the normal basal tone and peak pressure of contractions. It then discusses different abnormalities that can occur with contractions, including abnormal polarity, hypertonic dysfunction, precipitate labor in the absence of obstruction, tonic contractions and Bandl's ring in the presence of obstruction, hypotonic dysfunction/uterine inertia, contraction rings, and cervical dystocia. It provides details on each abnormality, their causes, and methods of management.
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Uterine rupture
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
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Cord prolapse
This topic contains definition, types, etiology, associated factors, diagnosis, management of cord prolapse.
Malpresentations&malpositions
This document discusses abnormal fetal positions and presentations during labor and delivery. It defines malpositions as longitudinal lie with the fetus not in occiput anterior position (such as occiput posterior or transverse) and malpresentations as anything other than vertex (such as breech, face, brow, shoulder, or compound). Management may include external cephalic version, vaginal delivery with maneuvers, or caesarean section depending on the specific presentation and other factors.
Uterine rupture
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
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This document provides information on obstructed labor, including its causes, clinical features, and management. It discusses how obstructed labor can be caused by disproportion between the fetal size and the birth canal size due to factors like contracted pelvis, large fetus, or fetal anomalies. In obstructed labor, strong uterine contractions are not effective in advancing labor due to the obstruction. This puts both mother and fetus at risk of complications like sepsis if not properly managed. Clinical features in the mother include exhaustion, pain, changes in vital signs, and specific findings on abdominal and vaginal exams. Risks to the fetus include asphyxia, bleeding in the brain, and pneumonia. The document outlines initial management steps and ultimately indicates that caesare
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Vacuum extraction is a method to assist in childbirth using suction from a cup placed on the baby's head to help with traction during contractions. There are different types of cups including metal, soft, and bird's cups. Vacuum extraction is indicated when forceps cannot be used and has advantages over forceps like less need for anesthesia and less compression force applied. Complications can include maternal lacerations and cervical injuries or fetal issues like cephalhematomas and scalp lacerations.
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Rupture of uterus
1. Uterine rupture can occur during pregnancy or labor due to a previous cesarean section scar or other procedures that weaken the uterine wall.
2. Uterine ruptures are classified as complete, where the entire scar tears, or incomplete, where only part of the scar tears. They can occur in the upper or lower uterine segment.
3. Symptoms of uterine rupture include abdominal pain, fainting, abnormal fetal heart sounds, and palpation of fetal parts in the abdomen. Diagnosis is confirmed by laparotomy. Early detection is important to prevent maternal and fetal complications.
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This topic contains definition, risk to fetus, causes, diagnosis, symptoms and treatment of vasa previa.
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Polyhydramios
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Labour is defined as the process of expelling the products of conception from the uterus through the vagina. Normal labour meets specific criteria including spontaneous onset at term, vertex presentation, natural termination with minimal assistance, and no complications. Abnormal labour deviates from these criteria and risks maternal and fetal health. Labour is initiated by various mechanical, hormonal and neurological factors that trigger uterine contractions and cervical changes over time, eventually resulting in delivery.
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This document discusses postpartum haemorrhage (PPH), defined as blood loss exceeding 500 ml following childbirth. It notes that PPH has various causes including an atonic uterus, trauma during delivery, retained placental tissues, and coagulation disorders. The primary types are those occurring within 24 hours of delivery. Management involves controlling blood loss, administering oxytocics, and may require interventions like uterine packing or hysterectomy in severe cases. Prevention strategies include active management of the third stage of labour and being prepared to treat PPH as a potential complication of childbirth.
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Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.
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Obstructed labour
Obstructed labor occurs when the fetus is unable to descend through the birth canal due to an impassable barrier, despite strong contractions. Worldwide, the prevalence of obstructed labor is 2-8% and the maternal mortality rate is 8%. The prognosis for subsequent pregnancies depends on the cause of obstructed labor in the previous pregnancy.
Puerperal sepsis
This document discusses puerperal pyrexia, which is a temperature of 100.4°F or higher within the first 10 days following delivery. It defines puerperal pyrexia and notes its historical prevalence. The causes are listed for different time periods postpartum, including atelectasis, urinary tract infections, endometritis, wound infections, and mastitis. Puerperal sepsis is also defined as an infection of the genital tract occurring after delivery. Risk factors and causes are provided. Signs and symptoms, investigations, prophylaxis, treatment including isolation, antibiotics, and potential surgical interventions are summarized.
Induction, augmentation and trial of labor
The document discusses induction of labor, including definitions, methods, and indications. It describes the three main methods of induction - medical, surgical, and combined. The medical method involves prostaglandins like misoprostol and oxytocin to induce contractions. The surgical method is artificial rupture of membranes. The combined method uses both medical induction and rupture of membranes. Some common indications for induction include post-term pregnancy, preeclampsia, and fetal growth restriction. Risks of induction include uterine hyperstimulation and failed induction requiring c-section. Strict monitoring is important during any induction procedure.
Induction of labour
Induction of labour is defined as inducing labour after 28 weeks of gestation but before spontaneous onset of labour, with the aim of vaginal delivery. Common indications for induction include post-term pregnancy, hypertensive disorders, diabetes, and premature rupture of membranes. Methods for induction include mechanical methods like laminaria tents, surgical methods like artificial rupture of membranes, and medical methods using prostaglandins or oxytocin drips.
Ruptured Uterus
Rupture of the uterus can occur spontaneously during pregnancy or labor due to factors like previous scarring or being a grand multipara. It can also be caused by trauma during procedures like external version or the use of oxytocics. Diagnosis involves abdominal pain and tenderness along with signs of shock. Treatment involves resuscitation and laparotomy to perform a hysterectomy, repair the rupture, or repair and perform a sterilization. Preventive measures include careful monitoring of at-risk mothers and avoiding unnecessary interventions.
rupture-of-the-uterus.ppt
Rupture of the uterus can occur spontaneously during pregnancy or labor due to factors like previous scarring or being a grand multipara. It can also be caused by procedures like cesarean delivery, myomectomy, or induction of labor. Ruptures are described as complete or incomplete depending on whether the peritoneum is involved. Diagnosis involves abdominal pain and tenderness along with signs of internal bleeding. Treatment requires resuscitation followed by laparotomy where a hysterectomy, repair, or repair with sterilization may be performed.
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Uterine rupture is a life-threatening condition where the wall of the uterus tears, potentially exposing the fetus and placenta to the mother's abdominal cavity. It most commonly occurs in women with a previous cesarean section scar. Signs include acute abdominal pain, fetal distress, and hemorrhage. Diagnosis is often made using ultrasound or MRI to detect tears in the uterine wall. Immediate exploratory laparotomy and cesarean delivery is usually required for treatment. Conservative uterine repair may be attempted for some cases but hysterectomy is often necessary due to severe hemorrhage. Prevention focuses on careful management of trial of labor for women with previous scars.
Rupture of uterus
1. Uterine rupture can occur during pregnancy or labor due to a previous cesarean section scar or other procedures that weaken the uterine wall.
2. Uterine ruptures are classified as complete, where the entire scar tears, or incomplete, where only part of the scar tears. They can occur in the upper or lower uterine segment.
3. Symptoms of uterine rupture include abdominal pain, fainting, abnormal fetal heart sounds, and palpation of fetal parts in the abdomen. Diagnosis is confirmed by laparotomy. Early detection is important to prevent maternal and fetal complications.
Uterine Inversion
Uterine inversion occurs when the uterus turns inside out, most commonly during the third stage of labor. It has an incidence of 1 in 2000 deliveries. The main causes are mismanagement of the third stage through excessive cord traction or fundal pressure. Uterine inversion can be first, second, or third degree depending on how far the inversion has progressed. Clinical presentation includes abdominal pain, postpartum hemorrhage, and shock. Management involves prompt recognition and replacement of the inverted uterus manually or through hydrostatic replacement, with tocolytics as needed. Prevention focuses on controlled cord traction and avoiding fundal pressure before signs of placental separation.
Vasa previa
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Prelabour Rupture of Membrane (PROM) by Sunil Kumar Daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Polyhydramios
Polyhydramnios is an excess of amniotic fluid, defined as over 2000 ml. It can be caused by fetal issues like congenital anomalies that impact swallowing or by maternal diabetes. Clinical signs include a fundal height higher than gestational age and a tense, cystic uterus that makes fetal parts difficult to feel. Management depends on the severity and chronicity, with acute cases warranting early rupture of membranes and chronic cases involving expectant management with potential termination if not improved. Complications can be maternal like preterm labor or fetal like prematurity.
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This document discusses cervical incompetence, also known as cervical insufficiency. It defines cervical incompetence as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor during the second trimester. The document outlines the causes, diagnosis, and management of cervical incompetence, with a focus on cervical cerclage procedures like the McDonald and Shirodkar techniques. Cervical cerclage involves surgically placing a suture around the cervix to reinforce it and prevent painless dilation during pregnancy.
Ectopic pregnancy
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in one of the fallopian tubes. This is a medical emergency that requires prompt treatment to stop potentially life-threatening bleeding. Most ectopic pregnancies occur in the fallopian tubes. While the incidence of ectopic pregnancy is rising due to increased rates of pelvic inflammatory disease, early diagnosis and treatment have reduced maternal death and illness.
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Labour is defined as the process of expelling the products of conception from the uterus through the vagina. Normal labour meets specific criteria including spontaneous onset at term, vertex presentation, natural termination with minimal assistance, and no complications. Abnormal labour deviates from these criteria and risks maternal and fetal health. Labour is initiated by various mechanical, hormonal and neurological factors that trigger uterine contractions and cervical changes over time, eventually resulting in delivery.
POST PARTUM HEMORRHAGE(PPH)
This document discusses postpartum haemorrhage (PPH), defined as blood loss exceeding 500 ml following childbirth. It notes that PPH has various causes including an atonic uterus, trauma during delivery, retained placental tissues, and coagulation disorders. The primary types are those occurring within 24 hours of delivery. Management involves controlling blood loss, administering oxytocics, and may require interventions like uterine packing or hysterectomy in severe cases. Prevention strategies include active management of the third stage of labour and being prepared to treat PPH as a potential complication of childbirth.
Breech presentation
Breech presentation refers to when the fetus is in a longitudinal lie with its buttocks as the lowest part. The document discusses the different types of breech presentations as well as their incidence, classifications, positions, etiology, diagnosis, and management both during pregnancy and delivery. Management during pregnancy includes attempting external cephalic version after 36 weeks to convert the fetus to head-first position. Management during delivery depends on factors such as gestational age and fetal/maternal conditions, and may involve vaginal delivery with assistance, total breech extraction, or cesarean section to avoid risks to the mother and fetus.
Cord prolapse & cord presentation
Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.
Induction of labour
This document discusses induction of labor, including definitions, purposes, indications, contraindications, factors for success, and methods. Induction of labor is defined as initiating uterine contractions before spontaneous labor, either through medical, surgical, or combined means, to achieve vaginal delivery. Common indications include post-term pregnancy, hypertension, and fetal growth issues. Methods include cervical ripening with prostaglandins or misoprostol followed by oxytocin infusion once the cervix is ripe. Artificial rupture of membranes is also discussed as a surgical induction method. A combined approach using cervical ripening followed by oxytocin is often most effective at inducing labor.
Obstructed labour
Obstructed labor occurs when the fetus is unable to descend through the birth canal due to an impassable barrier, despite strong contractions. Worldwide, the prevalence of obstructed labor is 2-8% and the maternal mortality rate is 8%. The prognosis for subsequent pregnancies depends on the cause of obstructed labor in the previous pregnancy.
Puerperal sepsis
This document discusses puerperal pyrexia, which is a temperature of 100.4°F or higher within the first 10 days following delivery. It defines puerperal pyrexia and notes its historical prevalence. The causes are listed for different time periods postpartum, including atelectasis, urinary tract infections, endometritis, wound infections, and mastitis. Puerperal sepsis is also defined as an infection of the genital tract occurring after delivery. Risk factors and causes are provided. Signs and symptoms, investigations, prophylaxis, treatment including isolation, antibiotics, and potential surgical interventions are summarized.
Induction, augmentation and trial of labor
The document discusses induction of labor, including definitions, methods, and indications. It describes the three main methods of induction - medical, surgical, and combined. The medical method involves prostaglandins like misoprostol and oxytocin to induce contractions. The surgical method is artificial rupture of membranes. The combined method uses both medical induction and rupture of membranes. Some common indications for induction include post-term pregnancy, preeclampsia, and fetal growth restriction. Risks of induction include uterine hyperstimulation and failed induction requiring c-section. Strict monitoring is important during any induction procedure.
Induction of labour
Induction of labour is defined as inducing labour after 28 weeks of gestation but before spontaneous onset of labour, with the aim of vaginal delivery. Common indications for induction include post-term pregnancy, hypertensive disorders, diabetes, and premature rupture of membranes. Methods for induction include mechanical methods like laminaria tents, surgical methods like artificial rupture of membranes, and medical methods using prostaglandins or oxytocin drips.
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This document discusses abnormal uterine action during labor, including definitions, types, causes, diagnosis, and management. The main types discussed are uterine inertia, ineffective contractions, abnormal polarity, incoordinate contractions including spastic lower segment and constriction ring, cervical dystocia, precipitate labor, tonic contractions, and retraction ring. The importance of assessing uterine tone, frequency and strength of contractions is emphasized for diagnosis. Management depends on the specific abnormality but may include oxytocin augmentation, amniotomy, operative vaginal delivery, or cesarean section.
RUPTURE OF UTERUS
Rupture of the uterus is a disruption of the uterine wall that can occur during late pregnancy, labor, or delivery. It has an incidence of 1 in 200 to 1 in 2,000 deliveries. Risk factors include previous cesarean sections. Diagnosis involves abdominal and vaginal examination finding signs of internal bleeding and sometimes extrusion of the placenta through the rupture. Treatment requires resuscitation followed by laparotomy for repair of the rupture or hysterectomy, with the latter usually performed due to the emergency nature of the condition. Prognosis after repair of a rupture is poor for future pregnancies due to high risk of re-rupture.
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UTERINE DISPLACEMENT.pptx
This document discusses various types of uterine displacement including retroversion, prolapse, and inversion. It defines each type and describes their causes, symptoms, diagnosis, and treatment options. Retroversion is a backward tilting of the uterus that can be first, second, or third degree. Prolapse occurs when the uterus descends into the vaginal canal due to weakened muscles and ligaments. Inversion is a rare condition where the uterus is turned inside out through the cervix. Surgical and non-surgical management such as pessaries, exercises, and hysterectomy are used depending on the type and severity of displacement.
Abnormal uterine action
The document discusses various types of abnormal uterine contractions that can occur during labor, including:
- Excessive contractions like polysystole, hyperstimulation, and tetanic contractions.
- Uterine inertia where contractions are inadequate.
- Tonic uterine contraction and retraction where the whole uterus undergoes spasm.
- Constriction ring where a localized ring of muscle forms around the fetus.
It provides details on symptoms, diagnosis, and management for each abnormality, with conditions like uterine inertia generally treated with oxytocin and procedures like caesarean often needed for severe tonic contractions or constriction rings.
CESAREAN SECTION.pptx
Caesarean section, also known as a C-section, is the surgical delivery of a baby through incisions in the abdomen and uterus. It is performed when vaginal delivery would put the mother or baby's life at risk or in other complicated pregnancies. There are two main types of uterine incisions used - the lower uterine segment incision and the classical or upper segment incision. While C-sections can save lives, they also carry risks for both mother and baby, such as infection, bleeding, injury, and complications with future pregnancies. Post-operative care involves monitoring for issues like fever, heavy bleeding or wound separation.
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Rupture of the uterus
This document discusses uterine rupture, a serious obstetric complication where the wall of the pregnant uterus tears. It has a high risk of maternal and perinatal mortality. Uterine rupture can occur during labor, delivery, or rarely during pregnancy. It has an incidence of 0.05% for all pregnancies, rising to 0.8% for those with a previous cesarean section. Causes include a weak scar from prior uterine surgery, obstructed labor, or uterine overstimulation from medications. Symptoms include abdominal pain, vaginal bleeding, and non-reassuring fetal heart rate. Diagnosis is usually made during emergency surgery, with ultrasound sometimes identifying signs of rupture. Treatment requires intensive resuscitation
Destruc jyoti
1. Abnormal uterine action, also known as uterine dysfunction, can cause dystocia or difficult labor by weakening or improperly coordinating uterine forces needed to efface and dilate the cervix. Some common types include excessive contraction, insufficient contraction (uterine inertia), and abnormal polarity.
2. Uterine inertia is characterized by weak, infrequent, and ineffective contractions. It can be primary from the start of labor or secondary after a period of good contractions. Management includes oxytocin stimulation and operative delivery if labor is prolonged.
3. Other abnormal types include spastic lower segment, constriction ring, cervical dystocia, and generalized tonic contraction. Cervical dystocia
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- Sclerosing adenosis appears as a lump and involves proliferation of breast ducts and stroma.
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Congenital malformations of female genital tract ppt
1) Congenital anomalies of the female genital tract refer to any physical abnormalities present at birth. The causes are mostly unknown but may involve hormone deficiencies, excesses, genetic factors or exposure to harmful substances.
2) Some common external anomalies include perineal or vestibular anus, ectopic ureters, and hymen abnormalities like imperforate hymen. Internal anomalies affect the vagina, uterus and ovaries.
3) Uterine anomalies are classified by the American Fertility Society and include conditions like arcuate uterus, bicornuate uterus, septate uterus and DES-related abnormalities. Clinical features may include infertility, dyspareunia and menstrual or obstet
Uterus rupture and uterus cervix rupture
Uterine rupture and cervical rupture can occur during or after labor and delivery. Uterine rupture is classified as complete or incomplete and occurs more often in women with prolonged labor, those who are grand multiparous, or those with a history of prior uterine surgery like cesarean section. Symptoms of impending rupture include abdominal pain and Bandl's ring. A complete rupture results in internal bleeding, shock, and a non-reassuring fetal heart rate. Cervical rupture is also dangerous and is classified by degree depending on how far the tear extends. Risk factors for cervical rupture include cervical rigidity and rapid delivery in breech presentation. The document provides guidance on diagnosing uterine versus cervical rupture based on history,
VENTRAL WALL HERNIA.pptx
Anatomy of anterior abdominal wall
Types of ventral hernias
Clinical features
Causes of hernia
Differential diagnosis
History/Examination
Investigations
Management
ABDOMINAL WALL IS MADE OF THESE LAYERS:
Skin
Subcutaneous tissue
Fascia:
fatty superficial layer Camper's fascia
membranous layer Scarpa's fascia
Muscle:
External oblique abdominal muscle
Internal oblique abdominal muscle
Rectus abdominis
Transverse abdominal muscle
Pyramidalis muscle
Fascia transversalis
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Placenta previa is a condition where the placenta implants in the lower uterine segment, either partially or completely covering the internal cervical os. There are four types ranging from low-lying where the placenta does not reach the cervical os to central/total where it completely covers the os. Risk factors include multiparity, advanced maternal age, previous C-sections, and smoking. The main symptom is painless vaginal bleeding which can occur in late pregnancy. Cesarean delivery is usually required to prevent complications like hemorrhage.
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- 1. Rupture of the uterus
- 2. DEFINITION • Disruption in the continuity of the uterine wall (endometrium, myometrium and serosa) any time beyond 28 weeks of pregnancy is called rupture of uterus
- 3. INCIDENCE • The prevalence widely varies from 1 in 2000 to 1 in 200
- 5. ETIOLOGY The causes of rupture of the uterus are broadly divided into: • Spontaneous rupture • Scar rupture • Iatrogenic rupture
- 6. SPONTANEOUS – DURING PREGNANCY (Complete & upper segment) • Previous damage • Grand multiparae • Congenital malformation of the uterus-Bicornuate uterus • Couvelair uterus
- 7. DURING LABOUR • Obstructive rupture- The rupture involves the lower segment extends through one lateral side of the uterus to the upper segment • Non – obstructive rupture – Grand multiparae. Weakening of the walls due to repeated previous births may be the responsible factors. The rupture usually involves the fundal area and is complete
- 8. Contd…. SCAR RUPTURE • Caesarean section scar • Myomectomy DURING PREGNANCY • Classical cesarean scar • Lower segment scar rarely ruptures during pregnancy DURING LABOR • The corneal resection for ectopic pregnancy is more vulnerable to rupture during labor. • Rare lower segment scar predominantly ruptures during labor
- 9. IATROGENIC OR TRAUMATIC • DURING PREGNANCY • Injudicious administration of oxytocin • Use of prostaglandins for induction of abortion or labour • Forcible external version under GA • Fall or blow on the abdomen DURING LABOUR • Internal podalic version • Destructive operation • Manual removal of the placenta • Application of forceps through incompletely dialated cervix • Injudicious administration of oxytocin for augmentation of labour
- 10. TYPES Depending on whether peritoneal coat is involved or not • INCOMPLETE RUPTURE- Incomplete peritoneum remains intact. Incomplete rupture occur in the lower segment • COMPLETE RUPTURE- Complete rupture occur following disruption of scar in the upper segment
- 11. DIAGNOSIS DURING PREGNANCY SCAR RUPTURE : Classical or hysterotomy • Dull abdominal pain over the scar area with slight vaginal bleeding • Tenderness on uterine palpation • FHS may be absent • A sense of something is giving way accompanied by acute abdominal pain and collapse
- 12. Contd…. SPONTANEOUS RUPTURE IN UNINJURED UTERUS • Acute pain with fainting attacks and may collapse • Features of shock • Acute tenderness on abdominal examination • Palpation of superficial fetal parts if rupture is complete • Absence of fetal heart rate
- 13. Contd… RUPTURE FOLLOWING FALL, BLOW OR EXTERNAL VERSION OR USE OF OXYTOCICS • Acute pain abdomen • Slight vaginal bleeding • Rapid pulse • Tender uterus
- 14. Contd… DURING LABOUR SCAR RUPTURE • Same as during pregnancy SPONTANEOUS OBSTRUCTIVE RUPTURE • Signs of obstruction • Pain becomes severe in an attempt to overcome obstruction • Pain becomes sever at the supra pubic region • Dehydrated and exhausted
- 15. SPONTANEOUS NON OBSTRUCTIVE RUPTURE • Agonising bruising pain, relief with cessation of contraction • Shock, internal haemorrhage, tenderness and vaginal bleeding RUPTURE FOLLOWING MANIPULATIVE OR INSTRUMENTAL DELIVERY • Sudden deterioration of general condition • Shortening of the cord following difficult vaginal delivery
- 16. PROPHYLAXIS • At risk mothers should deliver in the hospital • General anesthesia should not be used in version • Find out the cause for undue delay in labour in multiparae • Judicious selection of cases with previous LSCS for vaginal delivery • Careful watch of patients receiving oxytocin and avoid IM oxytocin • Internal podalic version should not be done in obstructed labour • Avoid forceps delivery or breech extraction in incompletely dialated cervix • Destructive operation should be done by an expert • Attempt to remove placenta accreta should be avoided
- 17. TREATMENT • RESUCITATION • LAPAROTOMY Hysterectomy Repair Repair and sterilisation