Obs: L&D - uterine rupture & inversion Flashcards
what is uterine rupture?
complication of labour where the muscle layers of the uterus ruptures
what is the difference between incomplete and complete rupture?
incomplete rupture or uterine dehiscence is where the is where the uterine serosa surrounding the uterus remains intact
complete rupture is where the serosa ruptures along with the myometrium and the contents of the uterus are released into the peritoneal cavity
what are the risk factors for uterine rupture?
- previous caesarean section - scar on the uterus becomes a weak point and may rupture with excessive pressure
- Vaginal birth after caesarean (VBAC)
- Previous uterine surgery
- Increased BMI
- High parity
- Increased age
- Induction of labour
- Use of oxytocin to stimulate contractions
note - RARE for uterine rupture to occur in a patient that is giving birth for first time
how will uterine rupture present?
acutely unwell mother
abnormal CTG
may occur with induction or augmentation of labour
- Abdominal pain
- Vaginal bleeding
- Ceasing of uterine contractions
- Hypotension
- Tachycardia
- Collapse
how is uterine rupture managed?
obstetric emergency
resuscitation and transfusion. may be required
emergency CS to remove baby, stop bleeding and remove uterus
what is uterine inversion
rare complication of birth when the fundus of the uterus drops down through the uterine cavity and cervix, turning the uterus inside out
what is an incomplete uterine inversion?
where the fundus descends inside the uterus or vagina but not as far as the introitus (opening of the vagina)
what is complete uterine inversion?
uterus descending through the vagina to the introitus
how does uterine inversion present?
large pph
maternal shock and collapse
incomplete may be felt with manual vaginal examination
complete may be seen at the introitus of the vagina
how is uterine inversion managed?
3 options:
- johnson manoeuvre
- hydrostatic methods
- surgery
what is the Johnson manoeuvre?
using a hand to push the fundus back up into the abdomen and into the correct position
whole hand and most of the forearm will be in the vagina and is help in place for several minutes and medications used to create a uterine contraction
ligaments and uterus need to generate enough tension to remain in place
what is the hydrostatic method?
used when johnson manoeuvre fails
filling the vagina with fluid to ‘inflate’ the uterus back to the normal position. requires tight seal at the entrance of the vagina, which is challenging to achieve
what are the surgical methods for managing a uterine inversion?
laparotomy is performed and the uterus is returned to the normal position
may require resuscitation and treatment of pph
