Dr. Wafa Fageeh Consultant Assistant professor King Abdul Aziz University

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Uterine Rupture and

Obstructed Labour.

Dr.Wafa Fageeh

Consultant Assistant professor

King Abdul Aziz University

Obstructed Labour

It is the resistance to the down passage of the fetus through the Pelvic Canal.

Obstructed labour


Pelvic tumour, contracted pelvis.

Congenital anomalies of the fetus

( hydrocephaly ).

Abnormal pattern of labour

in obstructed labour
Primary dysfunction labour

Cervical dilation

- Primi < 1.2cm/h

- Multi < 1.5cm/h

Secondary arrest of dilation same

dilatation over 2 hours.

Failure of descent of presenting


Presence of caput, moulding

Clinical manifestations in obstructed labour:

Exhaustion, distress.

Maternal tachycardia, pyrexia,

dehydration, ketonuria.

Uterine infections:

- Prolonged ROM.

- Number of P.V.

Fatal :

- hypoxia

- infection intracranial hemorrhage

Management of obstructed labour
Assessment of causes

Hydration, O , Pain relief.

H.V.S, Antibiotics


Uterine Rupture
Incidence less than one in five


Almost all uterine rupture occur

in multigravida.

Uterine rupture
Predisposing factors:

Weakness of the uterine wall due

to previous surgical scars

Excessive uterine action (abuse of

oxytocin )

Obstructed to the passage of the


Manoeuvres that impose risk of

uterine rupture.

Weakness of uterine wall
Previous caesarian section

- Classic

- Lower Segment

Previous hysterectomy, myomectomy,


Perforation during D & C, manual

removal of the placenta.

Survical stenosis due to previou

Excessive uterine action
Spontaneous in multigravida


Oxytocic drugs:

- Hyperstimulation

- Disproportion

Obstruction to the passage of the

Malpresentation, malposition,CPD.

Pelvic tumour.

Congenital anomalies of the fetus.

Manoevres-> Rupture uterus

Breech extraction on undilated


E. C.V

Difficult forceps.

Excessive fundal press


Fetal mortality 50 to 75 %

Anoxia, Aspraxia.

Intracranial haemorhage.


Symptoms and Signs

Before labour

Silent (dehiscence) found at the

time of elective section.

Without pain or tenderness

Fetus is not jeopardize

Swelling over the lower segment is

found sometime.

Symptoms and Signs
During labour (cont.)

Vaginal bleeding or concealed


Massive haemorhage

Sudden complains of a sharp

shooting pain in the abdomen

or mild to moderate pain and


Fetal di

Cessation of uterine activity

Uterine body maybe felt separate

Pelvic haematoma

Bizarre fetal position

Differential diagnosis

Abruptio placenta

Differential diagnosis of

Postpartum haemorrhage

Uterine atony

Retained placental tissue

Lower genital tract lacerations

Uterine inversion

Uterine rupture


Management of ruptured uterus



- Total

- Subtotal

Ligation of both internal iliac arteries

Next pregnancy C.S

When can we consider repair?

Stable general condition of

the patient.

Technically visible.

Desire for pregnancy.

When is Uterine repair difficult?

Unstable condition of patient.

Presence of large haematoma

in the broad ligament.

In longitudinal lateral

uterine incision (involvement

of uterine artery).

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