Lecture of rupture of the uterus

2021-03-21 12:00 AM

Incomplete rupture of the uterus (also called subperitoneal uterine rupture): Injury from the mucosa to tearing the uterine muscle but the peritoneum is intact, often rupture in the lower segment.

The rupture of the uterus is one of 5 obstetric complications that threaten the life of both mother and fetus. Usually, when the uterus has ruptured, the fetus will die and if not handled in time, the pregnant woman may also die. Before rupture of the uterus has a threatening period of rupture of the uterus, it is necessary to first detect the risk of rupture of the uterus for timely intervention. Uterine rupture usually occurs during labor, but can also occur during pregnancy. According to the Vietnam Association of Obstetrics and Gynecology, in 2000, uterine rupture accounted for 2.08% of the total 5 obstetric complications, but in 2001 it increased to 2.45%. Thus, uterine rupture is an issue that needs more attention to lower the rate of this accident.

A complete rupture of the uterus is a ruptured uterus, the uterus is torn from the mucosa through the muscle layer and the peritoneum makes the uterine chamber open to the abdomen.

Incomplete rupture of the uterus (also called sub peritoneal uterine rupture): Injury from the mucosa to tearing the uterine muscle but the peritoneum is intact, often rupture in the lower segment.

Complicated uterine rupture is damage to either the bladder or digestive tract.

Reason

There are three types of causes for uterine rupture, which are caused by the mother, by the fetus, and by the physician.

The reason is the mother

Due to the pelvis: The pelvis is distorted, narrow, abnormal.

Uterine conditions: malformed, underdeveloped uterus, twin uterus.

Scarring of the uterus: Scarring of the uterus from gynecological surgery such as fibrosis dissection, stitching of a hole in the uterus, repair of uterine abnormalities or abnormalities, or obstetric causes such as cesarean section old or damage to the uterine muscular layer when removing artificial vegetables or causing abortion.

A contraction of the uterus is too strong.

Maternal forward tumors such as ovarian cysts, uterine fibroids, pelvic or vaginal tumors prevent the fetus from falling.

Repeated birth, or malnutrition causes poor uterine muscle quality.

Causes of pregnancy

Full or partial pregnancy.

Abnormal fetuses, stick together, hydrocephalus.

Due to irregular positions, abnormal posture or poor bow.

The cause is physicians

Injuries due to childbirth or lower line procedure interventions tear the cervix and pull it to the lower segment.

Performing procedures with improper indications and incorrect techniques: forceps, suction, rotation.

Doing rough procedures: control of the uterus, internal rotation of the fetus.

Using an inotropic drug (Oxytoxin) is not correct.

Broken uterus during pregnancy

A rupture of the uterus during pregnancy usually occurs in people with an old uterine surgical scar, especially an old surgical scar from the body of the uterus or large fibrosis dissection or uterine shaping such as Strassman surgery. However, it can also be seen in people with a baby uterus, underdeveloped.

There is no typical uterine threatening or symptomatic uterine rupture.

Natural abdominal pain, more pain in the uterus, sometimes the disease is more localized pain in the affected uterine site (for example, fibrosis removal or lower pain in the old cesarean section). The pain intensified, and the pain rose, and then spread to the entire abdomen.

Appear signs of dizziness due to pain and blood loss.

On physical examination, the uterus was not found.

The abdomen is chiseled

The fetus is under the abdominal wall.

Do not see fetal heartbeat.

Vaginal examination did not see the fetus, with bright red blood under the hand.

Ultrasound shows that the abdomen is full of fluid, the fetus is pushed out of the uterus.

Management requires emergency surgery (see section Managing rupture of the uterus in labor).

Broken uterus during labor

Before rupture of the uterus is always a threatening period of rupture, it must be discovered for timely treatment, which will save both the mother and the child.

Threatened uterine rupture

Symptom

Function: Women writhing pain, prolonged pain and increased intensity make pregnant women scream.

The lower segment is stretched, sometimes up to the navel.

Later, the uterus is constricted in the lower segment, divided into two, gourd-like parts. The constriction ring is called the Bandl ring.

The lower wall is very thin, the pressure is very painful.

The two round ligaments are clearly palpable and tight. This signal coordinates with the Bandl ring called the Bandl-Frommel sign. Without treatment the uterus will rupture immediately.

The lower section is stretched thin so the fetus makes the lower segment bulge.

The attack has a long, intense uterus, short spacing between contractions.

The fetal heart is fast or slow, even or irregular due to lack of oxygen.

Vaginal exams can find the cause of the difficult delivery

Diagnose

Diagnosis is based on clinical symptoms.

Differential diagnosis:

A strained bladder.

Role of the fetus.

The head of the joint.

Fibrous nucleus or ovarian cyst is in the lower segment.

To solve

Strong contraction reliever.

If eligible: Put forceps to remove the pregnancy. After the procedure to check for rupture of the uterus and control the uterus for ruptured uterus under the peritoneum.

If there is not enough room for forceps to be placed, the leg will be removed.

Broken uterus during labor

Symptom

There is a stage of rupture of the uterus, but it is not detected or managed in time.

There are obvious signs of uterine rupture.

The woman was screaming violently, rolling around, sweating in pain.

The long, thin stretch with a very painful pressure: that is the point of breaking.

Pain gets better and then suddenly goes away, and at the same time, there is no uterine contraction.

Appears signs of dizziness.

The vagina is bright red blood.

The uterus no longer has the image of a gourd

No more Bandl-Frommel markers.

If the fetus has been pushed into the abdomen: Seeing the parts of the fetus lying under the abdominal wall. The uterus is a mass located next to the fetus. There is a whole-abdominal peritoneum induction.

If the fetus is still in the uterus, still see the shape of the uterus, the fetal part is not felt below the abdominal wall, touching the lower part there is a sharp pain point, which is where the uterus breaks.

Hear no fetal heartbeat.

Vaginal examination does not show the fetus or high fetus with red blood under the arms.

Urinary catheterization: If the bleeding is red and heavy, there is damage to the bladder.

Diagnose

Based on the clinical picture and symptoms, no specific test is needed because the clinical condition is clear, only necessary tests are needed for surgery and resuscitation.

Differential diagnosis

Striker vegetables: Usually detected before labor. during labor, the contraction is painless, bright red blood, large quantity.

Premature peeling vegetable: Usually appears in pregnant women with proteinuria syndrome, edema, hypertension, constant spasticity, pink or non-coagulating vaginal bleeding.

Diagnosis of rupture of the uterus during labor in people with old surgical scarring of the uterus

There is no threat of rupture.

Suddenly throbbing pain and the uterus is always ruptured, pregnant women have signs of dizziness.

Vaginal redness and dizziness.

After giving birth, the uterus has good elasticity, bright red bleeding in the vagina but no damage to the vulva, vagina or rupture of the uterus is found.

Control of the uterus reveals subperitoneal uterine rupture or complete rupture of the uterus.

Treatment

Must have emergency surgery. If not clearly defined clinically, it is possible to probe, to avoid omitting the case of subperitoneal rupture.

`` Resuscitation and dizziness by pain relief, infusion, fresh blood transfusion to compensate for circulating volume and electrolyte supplementation increases the patient's maximum blood pressure to 90 or 100 mmHg before surgery.

Management of uterine lesions depends on the need to have a baby, the degree of damage to the uterus, local conditions and the experience of the surgeon.

Uterine conservation: If the woman still needs to have a baby, the lesions are clean, the wound is small, the uterus rupture is not long, the uterine tear can be cut and trimmed, then stitched again.

Hysterectomy: People who have enough children, the wound is wide, messy, and has been ruptured for a long time, must have a partial hysterectomy. Usually cut across the edge where the uterus is torn. The remaining tip also depends on the patient and the experience of the surgeon. If you leave the tip cut too much, it can cause cut-out necrosis, causing peritonitis after surgery.

Clean the abdomen. If the abdomen is clean, newly ruptured, there is no need to drain. If the abdomen is dirty, infection is suspected, the cavity should be drained.

During surgery, pay attention to check for damage to the bowels and bladder.

After surgery, high doses of antibiotics must be used and combined, closely monitored in the postoperative period to detect postoperative infections.

Prevention

Pregnancy registration and management to detect pregnant women at high risk of uterine rupture.

People with scarring of the uterus take at least 3 years to get pregnant.

All people at risk must be managed and delivered at a surgical-capable level.

The commune level is not allowed to deliver birth for the 4th straw and the uterus height = 34 cm.

Close monitoring of labor, early detection of difficult delivery cases, signs of uterine rupture for early and timely management.

Oxytocin infusion must be strictly specified, under the right technique and monitored closely.

Procedural interventions must be assigned correctly, handled properly and gently and the procedure may be carried out only when qualified. If the uterus is suspected to be ruptured, it must be widely consulted and can be operated for exploration to avoid missing uterine rupture that could affect the life and health of the pregnant woman.