Transcript
B Y
M A G D Y A B D E L R A H M A N M O H A M E D
2 0 1 5
OBSTETRIC INJURIES
Rupture uterus.
Cervical & vaginal tears.
Perineal injuries.
RUPTURE UTERUS
More common with high parity. Why??
Etiology
I-Rupture during pregnancy.
Spontaneous
Uterine scar ( most common).
Rudementary horn at 4th or 5th m.
Incarcerated RVF.
External trauma.
Cont.
II- Rupture during labour.
Spontaneous
Obstructed labour.
Uterine scar.
Traumatic
Forceps.
Internal podalic version.
Destructive operations (historical).
Types of rupture
Complete.
Dehiscent scar.
Predisposing factor for scar weakness
Site: upper segment.
Bad coaptation of edge.
Poor hemostasis.
Infection.
short pregnancy interval after CS.
Clinical picture
History of prolonged labuor.
Picture of obstructed labour.
Vital signs
Abdominal examination.
Easily felt fetal part
Uterus felt away from fetus
Vaginal bleeding
Dehiscent scar ??
Diagnosis
C/P
U/S
Fetal bradycardia or death.
Fetus away from uterus.
Differential diagnosis
Concealed accidental Hge.
Advanced abdominal pregnancy.
Prevention
Early diagnosis of obstructed labour.
Proper use of ecbolics.
Careful intrauterine manipulation.
Treatment
Resuscitation.
Exploration.
Repair site of rupture if possible.
Check integrity of the bladder ….. Repair any tear.
Hysterectomy is life saving in some situations.
CERVICAL TEARS
Predisposing factors.
Instrumental deliveries.
Rapid dilatation of cervix.
Scarring of cervix.
Complications
Post partum Hge.
Upward extension to lower uterine segment.
Cervical incompetence. (delayed)
Diagnosis
Examination under anaesthesia.
Hold ant & post lips by ring forceps.
Treatment
Correction of general condition.
Immediate repair.
You should reach the apex of tear.
PERINEAL TEARS
Degree.
1st degree
2nd degree
3rd degree
4th degree
Etiology
Overstretch of perineum
Malposition
Extention of head before crowning.
Large head
Narow subpubic angle
Forceps.
Rapid stretch of perineum
Precipitate labour
Rigid or scared perineum
Iatrogenic.
Complication
Bleeding.
Infection.
Delayed.
Anal incontinence.
Rectovaginal fistula.
Treatment
Anatomical repair under anaesthesia
Preferred within 24 hour.
Aftercare:
In case of 4th degree
3 days nothing per mouth then 3 days oral fluid.
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