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
Rosenthal-Kloepfer Syndrome
Rosenthal-Kloepfer syndrome is a very rare disorder characterized by acromegaloid features, furrowed skin on scalp and face and corneal leukomas. Here we are presenting this rare syndrome in a man who presented with bila...
Renal Resistive Index: A Non-Invasive Indicator of Hepatorenal Syndrome in Cirrhotics
Introduction: Hepatorenal syndrome (HRS) is defined as unexplained kidney failure in a patient with liver disease. The poor prognosis is due to both liver and renal failure, the latter being due to intra-renal vasoconstr...
Primary Tubercular Myositis
A 41 yr male presented with left lower back swelling and discomfort in the right thigh since 2 months. There was no history of fever, weight loss, anorexia or any other pulmonary complaints. There was no history of traum...
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...
Review of role of roflumilast in the prevention of an exacerbation associated with the Chronic Obstructive Pulmonary Disease
COPD (Chronic Obstructive Pulmonary Disease), is a progressive disease that is characterized by persistent airflow limitation that leads to significant breathing problems in the patient. Sudden worsening of the symptoms...