RUPTURE OF THE UTERUS DEFINITION Dissolution of the

RUPTURE OF THE UTERUS

DEFINITION Dissolution of the continuity of the uterine wall any time beyond 28 weeks of pregnancy is called rupture of uterus

INCIDENCE 1 in 2000 to 1 in 200

ETIOLOGY SPONTANEOUS Ø DURING PREGNANCY (Complete & upper segment) • Previous damage • Grand multiparae • Congenital malformation of the uterus-Bicornuate uterus • Abruptio placentae Ø DURING LABOUR • Obstructive rupture(Lower segment through lateral side to the upper segment) • Non – obstructive rupture – Grand multiparae(Fundal area and complete)

Contd…. SCAR RUPTURE Caesarean section scar Myomectomy or uteroculoplasty IATROGENIC Ø 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 Ø 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

TYPES q. Depending on whether peritoneal coat is involved or not q. Incomplete peritoneum remains intact q. Incomplete rupture occur in the lower segment q. Complete rupture occur following disruption of scar in the upper segment

DIAGNOSIS DURING PREGNANCY q. SCAR RUPTURE : Classical or hysterotomy üDull abdominal pain over the scar area with slight vaginal bleeding üTenderness on uterine palpation üFHS may be absent üA sense of something is giving way accompanied by acute abdominal pain and collapse

Contd…. q. SPONTANEOUS RUPTURE IN UNINJURED UTERUS ü Acute pain with fainting attacks and may collapse ü Features of shock ü Acute tenderness on abdominal examination ü Palpation of superficial fetal parts if rupture is complete ü Absence of fetal heart rate

Contd… q. RUPTURE FOLLOWING FALL, BLOW OR EXTERNAL VERSION OR USE OF OXYTOCICS üAcute pain abdomen üSlight vaginal bleeding üRapid pulse üTender uterus

Contd… DURING LABOUR q SCAR RUPTURE ü Same as during pregnancy q SPONTANEOUS OBSTRUCTIVE RUPTURE ü Signs of obstruction ü Pain becomes severe in an attempt to overcome obstruction ü Pain becomes sever at the supra pubic region ü Dehydrated and exhausted q SPONTANEOUS NON OBSTRUCTIVE RUPTURE ü Agonising bruising pain , relief with cessation of contraction ü Shock, internal haemorrhage, tenderness and vaginal bleeding q RUPTURE FOLLOWING MANIPULATIVE OR INSTRUMENTAL DELIVERY ü Sudden deterioration of general condition ü Shortening of the cord following difficult vaginal delivery

PROPHYLAXIS 1. 2. 3. 4. 5. 6. 7. 8. 9. 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

TREATMENT q RESUCITATION q LAPAROTOMY ü Hysterectomy ü Repair and sterilisation