Uterine Rupture: Fatal Emergencies Continue to Occur Whys and Possibilities of Prevention
Journal Title: The Indian Practitioner - Year 2016, Vol 69, Issue 5
Abstract
Introduction: Uterine rupture is a fatal emergency, which leads to high maternal, perinatal morbidity, mortality continues to occur. Present article is with the objective of update and sharing. Present status: Uterine rupture could be complete or incomplete (inner layers torn but outer intact, or outer layer with part of myometrium torn but not extending into inner layer). Frequency in the developed countries was decreased because of availability, utilisation of quality care, but recent reports reveal increase, may be due to more interventions / more caesarean births. So there is renewed interest. Rupture could occur spontaneously during pregnancy in a weakened uterus of multiparity or previous caesarean section or other surgery or accident or intrauterine, manipulations. During labour it could be spontaneous, either because of obstruction due to contracted, deformed pelvis, malpresentations, multiple pregnancy, macrosomia, foetal anomalies, oxytocics, PCS, other surgery or perforation or trauma or previous uterine rupture or uterine anomaly. Diagnosis is delayed, unless possibility of rupture is kept in mind, because prior to circulatory collapse, signs, symptoms, may appear bizarre. Classic signs, sudden tearing pain, vaginal bleeding, cessation of contractions, regression of foetus are frequently absent. Non reassuring foetal heart rate may be indicative of imminent rupture. Thorough history /clinical examination are enough for diagnosis. Ultrasound shows abnormal foetal position / haemoperitoneum. Fatal exsanguination may supervene if broad ligament haematoma of incomplete rupture gives way relieving tamponading effect. Hypofibrinogenaemia may lead to complications. Therapy is general, depending on condition of patient, followed by laparotomy repair of rupture with or without tubectomy or hysterectomy depending on age, parity, patient’s condition, rupture site, skill of surgeon. Conclusion: It is essential to try prevention of rupture uterus, a catastrophic event by appropriate timely prenatal, intranatal evidence based care. If it occurs the mission has to be quality survival.
Authors and Affiliations
s Chhabra, P Borkar
Effect of an Ayurvedic formulation on plaque psoriasis
Psoriasis is a common inflammatory papulosquamous disease of skin with variable morphology, distribution, severity, and course. Psoriatic patients face many social and psychological problems because of its visibility, re...
Common Cold Revisited
The common cold, or upper respiratory tract infection, is one of the leading reasons for physician visits. Its impact on society and health care is large. Rhinoviruses are the most frequent cause. The virus is spread by...
Forgotten Lippes Loupe Accidental diagnosis for pain evaluation
Background: The intrauterine device (IUD) is the most commonly used contraceptive method in the world. Case: We report here a case of 64 year old female who was totally unaware of IUCD insertion done 40 years back until...
Antiphospholipid antibody and recurrent pregnancy loss
.
Endovascular De-vascularization of the Jugulo-tympanic ‘aggressive-Paraganglioma’
Background: Jugulotympanic ‘aggressive-paraganglioma’ (JTa-P) grows rapidly, within months intrudes in to jugular bulb, labyrinth and compresses the lower cranial nerves (LCN). Scanty cellularity and intense-vascularity...