Uterine Rupture Flashcards
What is uterine rupture?
Full thickness disruption of uterine muscle and overlying serosa
What are the types of uterine rupture?
Incomplete - peritoneum overlying the uterus is intact- uterine contents remains within uterus
Complete - peritoneum is torn and the uterine contents can escape into the peritoneal cavity
What are risk factors for uterine rupture?
Previous C-section - vertical incisions have higher risk than LSCS Previous uterine surgery such as myomectomy Induction - with prostaglandins Obstruction of labour Multiple pregnancy Multipartiy Breech extraction Internal version
What are signs/symptoms of uterine rupture
Sudden severe abdominal pain which persists between contraction
Shoulder tup pain
Vaginal bleeding - may be slight - bleeding in intraperioneal
Regression of presenting part
Tenderness
Palpable fetal parts
Hypovolaemic shock signs if haemorrhage - tachycardia, hypotension
Fetal distress, absent heart sounds
What are ddx?
Placental abruption - abdominal pain ± vaginal bleeding, woody tense uterus on palpation
Placenta praevia - painless vaginal bleeding
Vasa praevia - ruptured membranes, painless vaignal bleeding, fetal bradycardia
What investigations?
Cardiotocography
Changes in fetal heart rate patterns (recurrent or late decelerations) and prolonged fetal bradycardia - early indications for uterine rupture
If pre-labour US can be used
What initial management?
ABCDE approach
Obstetricia, midwives, anaesthetists
Protect airway
15L of 100% oxygen via a non-rebreathe mask
Cap refill, HR, BP, ECG
2 14G cannulas - take bloods
Give cross-matched blood to correct shock
Give additional blood products if required
GCS monitoring
Expose patient to identify other bleeding sources
What management?
If suspected preform category 1 CS and explore uterus
If rupture is small, repair
If cervix of vagina are involved, hysterectomy may be necessary
Post-op abx cover:
Cefuroxime, metronidazole
What is Mendelson’s syndrome? Prevention?
Cyanosis, bronchospasm, pulmonary oedema and tachycardia due to inhalation of gastric acid during general anaesthesia
Ddx - amniotic fluid embolism, cardiac failure
Pre-op H2 antagonists, sodium citrate, gastric emptying with metoclopramide, cricoid pressure and pre-extubation emptying of stomach to prevent
What is management for Mendelson’s syndrome?
Tilt patient head down
Turn her to one side and aspirate the pharynx
100% O2
Aminophylline by slow IVI and hydrocortisone STAT
Bronchial truss should be sucked out using bronchoscopy under GA
Abx given to prevent secondary pneumonia
Physiotherapy during recovery
What is amniotic fluid embolism?
Cause of maternal collapse
Cause is unclear
What are risk factors for amniotic fluid embolism?
Multiple pregnancy Maternal age > 35 CS Instrumental delivery Eclampsia Polyhydramnios Induction of labour Uterine rupture Placenta praevia Placental abruption
What are clinical features of amniotic fluid embolism?
Dyspnoea, chest pain, hypoxia, respiratory arrest Hypotension Fetal distress SEzirues Reduced conscious level Cardiac arrest DIC - nearly all within 48 hours
Anaphylactic type response occurs to amniotic fluid in maternal circulation
What are ddx?
Pulmonary embolism Anaphylaxis Sepsis Eclampsia MI
What investigations for amniotic fluid embolism?
Bloods - FBC, U&E, calcium/magnesium, clotting, ABG
ECG - ischaemic changes
CXR - pulmonary oedema
Diagnosis can only be made at post-mortem - fetal squamous cells in maternal circulation
