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Uterus Rupture in Pregnancy


Presentation

  • Now a day’s more and more pregnant women are presenting in shock in mid trimester of pregnancy.[omicsonline.org]
  • 'A 33-year-old asymptomatic woman presented at 22 weeks of gestation with a large herniation of the amniotic sac through the left uterine wall that was detected by routine ultrasonography,' he wrote.[dailymail.co.uk]
  • HEAD Baby brain IS a thing - but it makes women SMARTER So traumatic Peter Andre's wife Emily MacDonagh felt 'robbed' of a natural birth as she underwent emergency C-section What Dr Pierre-Emanuel wrote about the case: "A 33-year-old asymptomatic woman presented[thesun.co.uk]
  • High levels of caution should be exercised in patients with a history of prior uterine rupture, as they may present with atypical symptoms.[smj.org.sg]
  • Case presentation A 28-year-old fifth gravid woman with a history of one caesarean section presented to our department at 39 weeks and 6 days gestation with complaints of headache, epigastric pain and nausea.[casereports.bmj.com]
Asymptomatic
  • […] birth ALL IN YOUR HEAD Baby brain IS a thing - but it makes women SMARTER So traumatic Peter Andre's wife Emily MacDonagh felt 'robbed' of a natural birth as she underwent emergency C-section What Dr Pierre-Emanuel wrote about the case: "A 33-year-old asymptomatic[thesun.co.uk]
  • 'A 33-year-old asymptomatic woman presented at 22 weeks of gestation with a large herniation of the amniotic sac through the left uterine wall that was detected by routine ultrasonography,' he wrote.[dailymail.co.uk]
  • It’s often asymptomatic, does not pose any risk to mom or baby, and does not require repair. Again, I refer to Medscape : Uterine scar dehiscence is a more common event that seldom results in major maternal or fetal complications.[vbacfacts.com]
  • Furthermore in these 44 women only 6% of these patients had asymptomatic uterine windows at the time of repeat c-section.[tubal-reversal.net]
  • This is also known as a silent or incomplete rupture or an asymptomatic separation. In contrast to frank uterine rupture, uterine scar dehiscence involves the disruption and separation of a preexisting uterine scar.[ijogr.com]
Pallor
  • On examination she was in shock; pulse rate 140 bpm, systolic BP 84 mm of Hg and severe pallor. Her abdomen was tense with guarding. On pelvic examination, cervical os was closed. There was no bleeding per vaginum.[omicsonline.org]
  • Chest pain, pain between the scapulae, or pain on inspiration—Pain occurs because of the irritation of blood below the woman's diaphragm Hypovolemic shock caused by haemorrhage— Falling blood pressure, tachycardia, tachypnea, pallor, cool and clammy skin[en.wikipedia.org]
  • On presentation to us the patient’s general condition was fair, vital parameters were stable, and mild pallor was present. On abdominal examination, the uterus was 28 weeks and tonically contracted. Fetal heart sounds were absent.[jpgo.org]
Inflammation
  • History of inadequate scar healing Uterine damage resulting from the use of electrocautery led to increased risk of adhesion formation.In addition to more adhesions, the inflammation and necrosis associated with electrocautery may lead to delayed healing[explainmedicine.com]
  • For example, chronic endometritis (the inflammation of the uterine mucous membrane) that usually occurs before pregnancy. Changes connected with cicatxes.[infobaby.org]
Acute Abdomen
  • In addition, we recommend laparoscopy for the investigation of acute abdomen with unclear diagnosis in the first trimester of pregnancy.[medsci.org]
  • There were no clinical signs of acute abdomen. Cardiotocography showed no signs of fetal compromise, but contractions once every 3–5 minutes were noted. Her cervix remained closed.[smj.org.sg]
  • In: Acute abdomen during pregnancy. Springer; 2014. pp. 495–527. Google Scholar Berhe Y, Gidey H, Wall LL. Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013. Int J Gynecol Obstet. 2015;130:123–6.[bmcresnotes.biomedcentral.com]
Anger
  • The New England Journal Of Medicine The mum's MRI scan shows what was going on This photograph is of the French mother's MRI and her doctor, Pierre-Emanuel Bouet, a gynaecologist at Angers University Hospital, said he had never seen anything like it.[thesun.co.uk]
  • Pierre-Emmanuel Bouet, an OB/GYN at the Angers University Hospital in France and the lead author of the report, said he had never seen a case like this before.[dailymail.co.uk]
  • Pierre-Emmanuel Bouet, an OB/GYN at the Angers University Hospital in France and the lead author of the report, said he had never seen a case like this before. [ Here's a Giant List of the Strangest Medical Cases We've Covered ] Indeed, the condition[livescience.com]
  • You have so many feelings of disappointment, anger, frustration at the moment and no doubt think back to your daughter's birth a lot. Its been really tough going and I don't think you should feel any different than you do right now.[netmums.com]
Vaginal Bleeding
  • A sudden pause in contractions takes place after rupture, along with an abnormal fetal heart rate (usually bradycardia ), severe abdominal pain, vaginal bleeding, and hemodynamic instability.[amboss.com]
  • Placenta praevia – typically causes a painless vaginal bleeding. Vasa praevia – characterised by a triad of ruptured membranes, painless vaginal bleeding, and fetal bradycardia.[teachmeobgyn.com]
  • Abdominal pain, vaginal bleeding, and vomiting are classic findings.[7]. Bleeding Vaginal bleeding is a classic finding of UR.[7].[explainmedicine.com]
  • Other signs and symptoms of uterine rupture, such as abdominal pain, abnormal progress in labor, and vaginal bleeding, are less consistent and less valuable than bradycardia in establishing the appropriate diagnosis.[laparoscopyhospital.com]
  • After 13 minutes of uterine contractions, vaginal bleeding was evident. A cesarean section was performed, and the uterine rupture was found in the scar.[dovepress.com]
Uterine Hemorrhage
  • Conversely, therapy for the mother can generally be supportive and resuscitative until surgical intervention can be undertaken to arrest the often life-threatening uterine hemorrhage.[laparoscopyhospital.com]
  • Surgery for uterine repair is reserved for mothers who desire to have more children in the future, easy to control uterine hemorrhage, women with low chances of a transverse uterine rupture, and good general condition.[health.in4mnation.com]

Treatment

  • Management of the Ruptured Uterus Treatment The most critical aspects of treatment in the case of uterine rupture are establishing a timely diagnosis and minimizing the time from the onset of signs and symptoms until the start of definitive surgical therapy[laparoscopyhospital.com]
  • Timor-Tritsch IE Monteagudo A, Santos R, Tsymbal T, Pineda G, et al. (2012) The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J ObstetGynecol 207: 44.[omicsonline.org]
  • Minimal invasive treatment of uterine myoma: Laparoscopic radiogrequency myolysis. Korean J Obstet Gynecol 2006;49:1212–1218. 18. Rye JH, Kim KH, Park JS, Yang YS, Oh KY, Rho JH, et al.[synapse.koreamed.org]
  • Articles & News Awards, Honors and Leadership Articles & Journals News & Events The Legal Process The Intake Process Testimonials Verdicts & Settlements Community Involvement Cerebral Palsy About CP Causes & Risk Factors Signs and Symptoms Diagnosis Treatments[abclawcenters.com]
  • TREATMENT •Principles for the treatment of uterine rupture includes: •Intensive resuscitation •Emergency laparotomy •Broad spectrum antibiotics •Adequate post operative care 19.[slideshare.net]

Prognosis

  • Treatment and prognosis Uterine rupture is most often an obstetric emergency (especially if associated with pregnancy).[radiopaedia.org]
  • Prognosis [ 4 ] 6.2% of uterine ruptures are associated with perinatal death. 14-33% of women with uterine rupture require an emergency hysterectomy.[patient.info]
  • Uterine rupture in the Douala General Hospital, Cameroon: prevalence, risk factors, management and prognosis. Health Sci Dis. 2016;17(1):1–6. Google Scholar Gessessew A, Melese MM.[bmcresnotes.biomedcentral.com]

Etiology

  • Etiology Uterine rupture is primarily caused by uterine distention. Theoretically, this can occur at any stage of pregnancy ; however, it usually takes place during active labor because of the massive force exerted during contractions.[amboss.com]
  • Etiological classification Spontaneous rupture Scar rupture Traumatic rupture 13.[slideshare.net]
  • Nagarkatti RS, Ambiya VR, Vaidya PR (1991) Rupture uterus: changing trends in etiology and management. J Postgrad Med 37:136–139 PubMed Google Scholar 19. Mokgokong GT, Marivate M (1976) Treatment of the ruptured uterus.[link.springer.com]
  • T-shaped uterine incisions are reported to rupture in 4 to 9 percent of cases, while low-vertical incisions carry a rupture risk of 1 to 7 percent. 2 In comparison, rupture of an unscarred uterus occurs in one of 8,000 to 17,000 deliveries. 3, 23, 24 Etiology[aafp.org]

Epidemiology

  • Epidemiology Incidence : 1/4000 births References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. Etiology Uterine rupture is primarily caused by uterine distention.[amboss.com]
  • This study was conducted by Melissa Kaczmarczyk and colleagues from the Department of Epidemiology at Emory University, Atlanta, Georgia, USA and the Department of Medical Epidemiology and Biostatistics at the Karolinska Institute, Stockholm, Sweden.[nhs.uk]
  • Kathryn Fitzpatrick and colleagues from the National Perinatal Epidemiology Unit based at the University of Oxford in the UK found that from April 2009 to April 2010, 159 women experienced uterine rupture in the UK, of whom 139 had previously delivered[sciencedaily.com]
  • We found that many of the hospital maternity units across the country don't even see one case a year,' says Professor Marian Knight of the National Perinatal Epidemiology Unit at Oxford University, who led the study.[npeu.ox.ac.uk]
  • Epidemiology Incidence Uterine rupture in an unscarred uterus occurs extremely rarely (6.1/10,000 deliveries). [ 2 ] Following a previous caesarean section the incidence increases to 22-74/10,000 deliveries if vaginal birth after caesarean (VBAC) is attempted[patient.info]
Sex distribution
Age distribution

Prevention

  • However, delivery within this time cannot always prevent severe hypoxia and metabolic acidosis in the fetus or serious neonatal consequences.[laparoscopyhospital.com]
  • Prevention The primary responsibility of prevention lies on the doctor handling the pregnancy. They are supposed to assess the medical history of the mother and determine any risk factors.[medicalattorneyny.com]
  • Prevention is better than cure,” this idiom holds true in this particular complication of pregnancy, where an early diagnosis and management of hemodynamically stable patient is much better than explorative laparotomy for rupture uterus.[omicsonline.org]
  • Back to top Can You Prevent Uterine Rupture During Pregnancy? Yes, you can prevent uterine rupture through a planned cesarean section. It cannot be avoided if you go for a vaginal birth. Next, we answer a few commonly asked questions by our readers.[momjunction.com]
  • Contents: Symptoms of a Uterine Rupture Reasons Diagnostics The Treatment of the Uterine Rupture Complications and Consequences Preventive Measures Against Uterine Rupture Uterine rupture is a breach of uterine walls integrity during pregnancy and the[infobaby.org]

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