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
Causes:

Malpresentation,Malposition,CPD.

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



Part.

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

C






Uterine Rupture
Incidence less than one in five

thousand.

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



fetus.

Manoeuvres that impose risk of



uterine rupture.



Weakness of uterine wall
Previous caesarian section

- Classic

- Lower Segment

Previous hysterectomy, myomectomy,



metroplasty.

Perforation during D & C, manual



removal of the placenta.

Survical stenosis due to previou







Excessive uterine action
Spontaneous in multigravida

Obstruction.

Oxytocic drugs:



- Hyperstimulation

- Disproportion





Obstruction to the passage of the

Fetus
Malpresentation, malposition,CPD.

Pelvic tumour.

Congenital anomalies of the fetus.




Manoevres-> Rupture uterus

Breech extraction on undilated



cervix.

E. C.V

Difficult forceps.

Excessive fundal press






Fetus

Fetal mortality 50 to 75 %

Anoxia, Aspraxia.

Intracranial haemorhage.

Infection.



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



haemorhage

Massive haemorhage

Sudden complains of a sharp

shooting pain in the abdomen

or mild to moderate pain and

tenderness.

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

Coagulopathy





Management of ruptured uterus
Resuscitation

Repair

Hysterectomy

- 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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