Rupture of uterus

1
Rupture of uterus

• Ob Gy Department, First Hospital, Xian Jiao
  Tong University
• SHU WANG

2
Etiology

• Fetal descent arrest
• Surgical delivery history
• Misuse of oxytocin
• Obstetrical operative injury

3
Clinical findings

• Impending uterine rupture
• Abdominal pain and tenderness
• Pathologic retraction ring
• Increased uterine irritability
• Hematuria
• Sign of hypovolemic shock
• Fetal distress or fetal death

4
Clinical findings

• Uterine rupture
• complete uterine rupture
• severe abdominal pain
• Sign of hypovolemic shock
• PEabdominal tenderness fetal body under
  abdominal wallabsence of fetal heart
• PVvaginal bleedingacent of fetal presentation
• incomplete uterine rupture
• mild symptoms and signs
• Haematoma in broad ligment

5
Diagnosis differential diagnosis

• Diagnosis
• History
• Symptom
• Physical signs
• B echo
• Differential diagnosis
• Severe placenta abruption
• Intrauterine infection

6
treatment

• Impending uterine rupture
• to inhibit uterine contractiongeneral
  anesthesia,dolatin,et al.
• cesarean section
• Uterine rupture
• reverse the shock
• perform operation
• Preventive antibiotic using

7
Postpartum hemorrhage

• Definition
• excessive bleeding (gt500ml )following
  24h after fetal delivery

8
Etiology

• Uterine atony
• General factor
• excessive nervous of parturient
• excessive sedative drug
• chronic disease
• weakness,et al.

9
Uterine atony Etiology

• Obstetrical factor
• prolonged labor,
• previa placenta,placenta abruption,
• severe anemia
• intrauterine infection,et al.

10
Uterine atony Etiology

• Uterine factor
• maldevelopment of myometrium fiber,
• malformation of uterine,
• overextendeduterientwins,polyhydramnios

11
Placenta causation

• Retention of placenta tissue
• Placenta adhesion
• Placenta implant
• Retained placenta and membrane tissue

12
Soft tissue laceration

• Rigid perineum
• Precipitate or uncontrolled delivery
• Inappropriate vaginal surgey
• Due to episiotomy

13
Coagulation defect

• Obstetrical complication disease
• DIC in amniotic fluid embolism,severe
  placenta abruption,PIH,fetal death.
• Parturient combined with hematological disease

14
Clinical presentation

• Vaginal bleeding
• With atony uterine
• With placenta retention
• With coagulation defect
• With large haematoma
• Sigh of hypovolemic shock
• Dizziness,paleness,mild pulse,hypotension

15
Diagnosis

• Uterine inertia
• Placenta examination
• Soft tissue laceration
• cervix laceration
• Vaginal laceration
• Perinium laceration
• Coagulation defection
• History
• Symptom
• Laboratory investigation

16
Treatment

• Uterine atony
• Explore the reason of bleeding
• Uterine massage
• Oxytocin infusion
• intrauterine bandage padding
• Pelvic vessel ligation
• hysterectomy

17
Treatment

• Retained placenta tissue
• manual exploration of the uterine
• curretage
• Soft tissue laceration
• repair the laceration
• Clear the haematoma
• Coagulation defect
• blood replacement