uterine rupture

Question 1

Definition

Answer 1

It is the defect pf the wall of the uterus as a result of increased ….pressure. It may be divided into:-
a) complete - endometrium, myometrium and serosa
b) incomplete - only endometrium and myometrium

Question 2

Diagnosis

Answer 2

a) Persistent/increase in suprapubic pain and tenderness
b) Sudden stop of uterine activity and transient relief of symptoms
c) Vaginal bleeding or gross hematuria
d) Increase pulse rate, tachycardia, hypotonia (beginning)
e) Alteration of abdominal swelling – if fetus is wholly or partially extruded
into abdominal cavity, uterus contracts and is detected as separate mass in
cavity.
f) Re….of fetal presenting part, vaginal examination 🡪 empty pelvis
g) Disappearance of fetal heart tones
h) Palpable fetal parts …and abdominal – all ?

Question 3

Clinical picture of complete rupture

Answer 3

i) Suprapubic pain and tenderness, sudden stop of uterine contraction
ii) Tachycardia and increase pulse rate
iii) Most important : hypovolumic shock and pain shock
iv ) Signs of peritoneal irritation by blood

Question 4

Emergency management

Answer 4

i) Vein puncture to measure CVP and for infusion therapy, (plasma,
saline,glucose), urine catheter
ii) Laparotomy to arrest haemorrhage. In lateral ruptures 🡪 damage of uterine
artery and massive bleeding that obscure operative field. Therefore,
ligation of hypogastric artery (internal iliac artery).
iii) Surgical treatment maybe :-
a) repair of rupture - …?
b) Hysterectomy :
1. subtotal – complete incision through lower segment (if
emergency)
2. total – if patient condition permits
iv) Post operation – continue blood replacement, CVP monitoring,
coagulation status, AB therapy-prophylaxis monitoring renal function,
continous UB drainage for 10-14 days if UB damaged.