35. Lesions of the birth canal. Uterine rupture Flashcards
risk factors of genital tract lacerations?
- Fetal macrosomia
- Malpresentation
- Uncontrolled delivery
- Prolonged second stage of labor
presentation of genital tract laceration/ trauma
- Hematoma or bleeding laceration of the female genital tract.
- Features of retroperitoneal hematoma (pelvic pain, signs/symptoms of hypovolemia).
what is the treatment for a genital tract laceration/trauma
Local surgical care (suturing).
types of genital tract lacerations and their causes
- Cervical lacerations (most commonly due to forceps use)
- Lower vaginal laceration (most commonly due to episiotomy)
- Uterine rupture
what is a complete uterine rapture?
complete disruption of all uterine layers, including the
serosa, leading to clinically significant changes in maternal or fetal status.
what is Incomplete uterine rupture (dehiscence uterus)?
incomplete disruption in which the perforation is covered by intact serosa; often discovered incidentally on C-section.
what are the risk factors of uterine rapture?
> 90% associated with a prior uterine scar either from
cesarean section or other uterine surgery.
- Vaginal birth after cesarean (VBAC).
- Labor or delivery association → improper oxytocin use, excessive fundal pressure.
- Spontaneous rupture on the basis of placenta accreta, multiple gestation, invasive mole, choriocarcinoma.
presentation of uterine rapture
- Acute-onset abdominal pain (different characteristics compared to pain of contraction)
- Vaginal bleeding
- Fetal distress
- Loss of fetal station
- Maternal hemodynamic instability
- Changes in uterine contraction pattern (↑ or ↓)
diagnosis of uterine rapture
Clinical or radiologic identification of complete disruption of all uterine layers.
what do we do in case of uterine rapture?
Emergency cesarean delivery via laparotomy, followed by hysterectomy.
Conservative approach (uterine repair) may be attempted in specific cases.
