Rupture of Uterus

Rupture of Uterus

Rupture of uterus is a serious obstetric accident. It is common in developing countries where antenatal care is very poor. It is an countered in women of high parity. Ruptured uterus may be complete or incomplete. Incomplete does not invoke the peritoneal covering of the uterus but complete involves all uterine muscle layers.

Causes

·              Obstructed labour e .g (CPD, mal presentation)

·              High parity

·              Previous trauma to the uterus e.g CLS, Myomectomy, D & C.

·              Difficult obstetric manipulation e.g Harrison – the presence of previous uterine scar.

·              Instrumental delivery use of forceps or vacuum, craniotomy, decapitation.

·              Abuse of oxytocic drugs e.g in the presence of previous scar.

Clinical Features Of Ruptured Uterus

Occurs in the last four weeks of pregnancy in cases of previous caesarean section or sometimes early stage of labour. The term silent rupture is used as the symptom may not be dramatic usually symptoms are:

·              Law abdominal pain which be accompanied by vaginal bleeding

·              Patient may feed faint and goes into sever shock

·              Cold and damming skin

·              Low B/P,rapid and thready pulse

·              Contractions and abdominal pain ceases as soon as the fetus is extruded into the peritoneal cavity.

·              On abdominal palpation

There is an area of tenderness

Fetal parts are easily palpated

No fetal movement and fetal heart sound ceases.

Management: 

·              Midiwife should inform the doctors immediately

·              Observe vital sign quarter hourly.

·              Gave analgesic- morphin 15mg 1.m

·              Set up I.V normal saline

·              Cross match blood for transfusion of immediate laparatomy possibly hysterectomy and stabilization silent ruptures are sometimes discovered after delivery, uterine routine exploration of the uterus. In this case no treatment is necessary but the woman is observed closely for 48-72hrs.

If hystectomy was not done, on discharge she should be informed to avoid pregnancy for about 2 years. She should be told to report in a hospital as soon as she gets pregnant and inform them about her previous operation. Elective ceasarean section must be done near term with subsequence pregnancy.