Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

obstetrics > 33/ 34 Uterine rupture and other birth traumas of the mother. > Flashcards

33/ 34 Uterine rupture and other birth traumas of the mother. Flashcards

1
Q

what is uterine rupture ?

A

Disruption in the continuity of the all uterine layers (endometrium, myometrium and serosa) any time beyond 28 weeks of pregnancy is called rupture of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the etiology of uterine rupture ?

A

1) During pregnancy

SPONTANEOUS - later months

a) intact uterus = multipara , congenital malformation of the uterus , placental abruption

b) scared uterus
through c section , hysterectomy , dilation and curettage

IATROGENIC

a) traumatic - external cephalic version
b) oxytocins

===============
2) during labour

SPONTANEOUS

a) intact uterus
obstructive labour - involves the lower segment and usually extends through one lateral side of the uterus to the upper segment

non obstructive - grand multipare

b) scarred tissue -

IATROGENIC

a) traumatic - internal version , manual removal of placenta
b) oxytocins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which type of scarring rarely ruptures during pregnancy ?

A

lower segment

Uterine scar, following operation on the nonpregnant uterus such as myomectomy or metroplasty hardly rupture as the wound heals well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the two main types of uterine rupture ?

A

complete - all layers and torn

incomplete
when the uterine muscle is separated but the visceral peritoneum is intact also called uterine dehiscence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the symptoms of uterine rupture ?

A

when it is about to happen
= severe abdominal pain
increased contraction - hyperactive labour
bandl ring forms above the belly button due to powerful contraction of the upper segment

in uterine rupture
*severe abdominal pain

sudden pause in contractions

fetal distress - bradycardia

  • vaginal bleeding
  • regression of presenting fetal part - loss of station
  • palpable fetal part through rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how can we diagnose uterine rupture ?

A

US

diagnostic triad - painful bleeding , loss of station , loss of fetal heart rate absent or irregular

also a sense of something giving away

uterine rupture is confirmed by laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

management of uterine rupture ?

A

resuscitation (blood transfusion) and laparotomy

laparotomy :
1) hysterectomy (quick subtotal hysterectomy)

2) repair - most applicable with scar rupture when the margins are clear

if during labour - c section and laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are common sites of tear ?

A

posterior laceration of vulva (opening of vagina, major and minor labia , clitorius)

parauretheral tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the pelvic floor (inner most ) ?

A

it is the pelvic diaphragm

formed of levitator ani (puborectalis , pubococcygeus , ischiococcygeus) and coccygeus muscles covered by parietal fascia

gaps in the pelvic wall - urogenital hiatus - where the urethera and vagina pass

rectal hiatus - anal canal pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

describe the anatomy from deep to superficial after the pelvic floor ?

A

urogenital diaphragm - external to pelvic diaphragm within the deep pelvic pouch - disc shape around the urethera

= deep transverse perineal , sphincter urethera and internal and external fascia covering

=======
then it is the perineal membrane does NOT EXIST OVER THE ANAL TRIANGLE

superior to the perineal membrane is the deep perineal pouch

inferior perineal membrane - superficial perineal pouch

=====
in the superficial pouch

  • anterior urogenital triangle (anal triangle posteriorly)

ischiocavernous
bulbospongiosus - surrounding the vagina - aids in secretion of bartholin gland
superficial transverse perineal

=====

fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the perineum ?

A

diamond shaped space
superior;y - pelvic floor

ant- pubic symphysis and pubic bones

laterally - ischiopubic rami/ nferioir pubic rami, and ischial tuberosity , scarotuberous lig

posteriorly - coccyx

inferiority - skin and fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

perineal injury is more common in whom?

A

primigravida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what causes perineal tear?

A

minor injury quite common which is second and first

third and fourth degree is due to mismanaged second stage of labour :
big baby ?3kg 
pelvic outlet contraction and narrow pubic arch 
should dystocia 
scar- epstiotimy 
midline epstiotomy 
malpresentation - breech and face 
forceps or vacuum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the degree in perineal tear ?

A

first - limited to vaginal mucosa and skin of introits

second degree - extension to fascia and muscles of perineal body (muscles)

third degree - anal sphincter
a- less than 50 percent of EAS
b - more
c - both external and internal AS

fourth degree - rectal lumen and extends through rectal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the clinical manifestations of perineal tear ?

A

acute :
>post partum hemorrhage

> perineal pain

> urinary retention and incontinence
rectal incontience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the prevention of perineal tear ?

A

tile epstiotomy given in all primigravida

proper support of perineum at time of crowing and expulsion of head

17
Q

what is the management of perineal tear ?

A

lacerations repeaired within 24 hrs of delivery

if after 24hrs - antibiotics given FIRST an repaired within 3 months

best suture material catgut and fine mono filament for skin

first degree - no suturing required or interrupted

second degree 
vaginal tear is repaired first 
should include deeper tissue to limit the dead space 
with interrupted sutures 
with chromic catgut

=====

after care = similar to epstiotomy 
low residual diet - milk etc 
lactulose 
broad spectrum antibiotics in intraoperative and postoperative 
physiotherapy and pelvic floor exercises
18
Q

what are the complications of perineal care if left untreated ?

A

infection - perineal abcess
hemorrhagic shock
3rd to 4th tear if left untreated - urinary and fecal incontinence
uterovaginal prolapse

19
Q

what is the classification of inversion of uterus ?

A

1 - incomplete minimal fundus descension but has not crossed though the cervix

2 - complete
the fundus has passed through the cervix but not outside vagna

3 - outside vagina

4 - uterus , cervix and vagina completed turned inside out

20
Q

causes of inverted uterus ?

A

Spontaneous (40%): localized atony on the placental site over the fundus associated with sharp rise of intraabdominal pressure as in coughing, sneezing or bearing down effort.

excessive cord traction when placenta unseparated
or
when the uterus is atonic especially when combined with fundal pressure

excessive fundal pressure when relaxed uterus

placenta accreta

21
Q

signs and symptoms of inversion of uterus ?

and diagnosis ?

A

v dangerous
hemorrhage

shock - initially disproprtinte with the amount of blood loss

hypovolemic shock

severe abdominal pain
hypotension with

bradycardia
uterine fundus no longer palpable
masss in vagina or in vaginal examination

=========
Cupping or dimpling of the fundal surface
Bimanual examination
us

22
Q

what is the treatment for inversion of uterus

A

emergency -intravenous crystalloids (normal saline or lactated Ringer’s solution)

blood transfusion

general anaesthesia

Discontinue uterotonic drugs since uterine relaxation is needed for replacement of the uterine fundus.

if placenta partially attached - peeled out before replacement of uterus

if placenta attached only removed leave it on - only removal after replacement and uterus starts contracting

attempt to replace the fundus
- using gloved hand placing a hand inside the vagina and pushing the fundus along the long axis of the vagina toward the umbilicus (Johnson’s Maneuver)

the part of the uterus which came down last should be replaced first

once replaced oxytocin infusion started before removing uterine hand.

antiobotcs also administered

========

if the uterus is still relaxed - bimanual compression - finsting hand to anterior fornix of vagina and grabbing the back of the fundus of the uterus through abdominal

or

Sullivan hydrostatic method (can be used for 2nd degree) - Warm sterile fluid (up to 5 liters) is gradually instilled into the vagina through a iv tube in posterior fornix .
The vaginal orifice around the wrist of the assistant and by labial .

======

Haultain operation if the above fails

vertical incision – through the posterior portion of the cervix to incise the constructing cervical ring allowing the fundus to be manually replaced into the through the vagina

23
Q

During delivery, which of the following muscles is most likely to be torn?

A

superficial transverse perineal muscle

24
Q

vaginal tears are caused by ?

A

forceps or vacuum delivery
in such cases the tears are extensive and BRISK hemorrhage

colporrhexis - rupture of vaginal vault (or upper 1/3 of vagina) caused secondary to primary cervical tear
Primary colporrhexis is defined as a tear limited to the vaginal vault without cervical or uterine extension
it is said to be complete when the peritoneum is opened up

25
Q

what is the treatmnet of vaginal tears ?

A

exploration under general anesthesia for brisk hemorrhage -

chromic catgut sutures
if extensive

intravaginal plugging also added by roller gauze soaked with glycerine and acriflavine
this plug is removed after 24 hrs

if persists - arterial embolisation or ligation

26
Q

what is the most common traumatic post partum hemorrhage ?

A

cervical tear

27
Q

what are the causes for cervical tear ?

A

iatrogenic - forceps or vacuum , breech extraction through incompletely dilated cervix

rigid cervix - from scars (conization) or congenital

or extremely vascular cervix - placenta previa

28
Q

what is the diagnosis of cervical tears ?

A

exploration of uterovaginal canal under good light

first - not over 2cm
second - more than 2 cm but does not involve the vaginal fornices
third - extends to vaginal fornices - v dangerous

29
Q

what is the treatmnet of cervical tear ?

A

up to 2cm is inevitable - first degree
they heal rapidly

only deep cervical tear associated with bleeding should be repaired soon after delivery of the placenta - under general anaesthesia in lithotomy position need good light and suturing with catgut vicryl and sponge forceps

30
Q

what are the anatomical types of pelvic hematoma ?

A

depend on whether it is above or below the levitator ani

infralevator - common
MOST COMMON - VULVA HEMATOMA

supralevator - uncommon

31
Q

what is the causes for cause of vulva hematoma ?

A

improper hemostasis during repair vaginal , perineal tears or epstiotomy wound

  • which is failure to take precaution in suturing the apex of tear or obliterate the dead space while suturing the vaginal walls
32
Q

what are the signs and symptoms of INFRALEVATOR pelvic hematoma ?

A

persistent and severe pain of the perineal region

maybe rectal tenesmus

urinary retention

Variable degrees of shock

Tense swelling at the vulva which becomes dusky and purple in color and tender to touch

33
Q

what is the treatmnet of infralevator pelvic hematoma ?

A

less than5 cm - conservatively with cold compress and watchful waiting and analgesia.

larger - IV saline
under general anesthesia
evacuation of any clots present,
surgically drained. To do this,
dead space should be obliterated with deep mattress sutures
You might also be given an antibiotic to prevent an infection.
closed suction drain may be kept in that place for 24 hrs

selective arterial embolisation

34
Q

what are the causes for supralevator hematoma ?

A

extension of cervical lacerations
primary coloprrhexis

lower uterine segment rupture

rupture of paravaginal venous plexus adjacent to the vaginal vault

35
Q

what is the diagnosis of supralevator hematoma

A

made late - due to no pain

shock which is unexplained

abdominal examination - swelling above inguinal lig pushing uterus to contralateral aside

vaginal examination - occlusion vaginal canal by bulge or swelling felt through fornix

rectal examination confirms a boogy mass

US

36
Q

what is the treatmnet of supralevator hematoma ?

A

laparotomy

bleeding points sutured and ligated

obstetrics (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions