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INTRODUCTION
1` 1 min To Introduce self. INTRODUCTION OF SELF : Student teacher is -
Good Morning everyone, Myself Miss Sangita Vasant Patil talking.
from 1 st year Msc nursing student going to teach you about
the Uterine Rupture and Cervical tear.

2 2 min To Introduce the INTRODUCTION OF TOPIC :


Topic. A uterine rupture is a tear in the wall of the uterus, most Student teacher is
often at the site of a previous c section incision. Fortunately, talking and asking PPT What is mean by
these ruptures are relatively rare events – exceedingly rare for questions. students are Uterine Rupture and
women who've never had a c-section, other uterine surgery, or responding cervical tear?
a previous rupture. The vast majority of uterine ruptures occur
during labor, but they can also happen before the onset of
labor.
Student teacher asking
3. 2 min questions “have you PPT
To recall students PREVIOUS KNOWLEDGE OF STUDENTS: learned the anatomy
previous knowledge Students might have learned anatomy and physiology of and physiology of
female reproductive system; they had lecture on structure of female genital tract in
Uterus. your 1 st year GNM
Student teacher
explaining, students
are listening and
repeating.
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RUPTURE OF UTERUS:
To define Uterine Definition :
4. 2 min Rupture A rupture is defined as an abrupt tearing of the uterus and Student teacher PPT
can be complete or incomplete explaining, students How you will define
Uterine rupture is giving way of gravid uterus or are listening and Uterine Rupture?
dissolution in the continuity of Uterine wall any time after repeating.
28 weeks of gestation with or without expulsion of the
fetus. Rupture of Uterus is a serious condition endangering
life of mother and fetus.
Incidence In India :
INCIDENCE:
 0.07/1000 births in developed countries
 0.62/1000 births in India
5. 3 min To list down the causes ETIOLOGY OF UTERINE RUPTURE : Student teacher is Pamplets What is the etilogy of
of Uterine Rupture. Causes in current Pregnancy: distributing the Uterine Rupture?
1.Antepartum Factors : pamplets to reach
i. Spontaneous severe uterine contractions row and explaining
ii. Induction of labor using oxytocin or prostaglandins risk factors, students
iii. Intra-amniotic saline or prostaglandins instillation. are listening and
iv. Perforation by internal uterine pressure catheter participating in
v. External trauma ; sharp or blunt activity.
vi. External cephalic version
vii. Over distension of uterus due to hydramnious,
multiple pregnancy.
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2. Intrapartum factors
i. Obstructed labor due to malposition,
malpresentations and other causes.
ii. Internal podalic version
iii. Difficulty instrumental delivery
iv. Breech extraction
v. Fetal anomaly like hydrocephalus
vi. Excessive uterine pressure in labor.
vii. Difficulty manual removal of placenta
3.Aquired causes:
i. Morbidity adherent placenta
ii. Gestational trophoblastic disease
iii. Adenomyosis
iv. Sacculation of entrapped retroverted uterus. Student teacher is
6. 5 min To describe traditional TYPES OF UTERINE RUPTURE : explaining, students PPT Which are the types
and etiological There are two types of uterine rupture namely complete are listening and of Uterine Rupture?
classification of Uterine rupture and incomplete rupture. participating in
Rupture? 1. Complete Rupture: rupture of all the layers including discussion.
the peritoneum is torn and the uterine contents escape into
the peritoneal cavity .It causes results in death of the
fetus.
2. Incomplete Rupture: In incomplete rupture .the
visceral peritoneum is intact and usually the fetus remains
in the cavity.
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ETILOGICAL CLASSIFICATION :
The etiological classifications of uterine rupture is as
follows:
1. Spontaneous rupture
2. Scar rupture
3.Iatrogenic rupture
Spontaneous Uterine Rupture
During Pregnancy:
An intact uterus ,without prior injuries ,rarely ruptures
during pregnancy .However ,the various causes are:
1. Past history of dilatation and curettage operation
or manual removal of placenta causing weakness
of uterus making it liable to rupture.
2. Grand multiparty due to replacement of more and
more muscular tissue by fibrous tissue making
uterus weak and liable to rupture.
3. Counvelaire uterus due to dissection of uterine
wall.
4. Congenital malformations of the uterus like
bicornuate uterus.
5. Congenital fetal abnormalities (hydrocephalus)
6. Morbidity adherence placenta.
7. Collagen disorders like Ehlers Danlos Syndrome.
During labor:
Spontaneous uterine rupture can occur in labor in an
intact uterus in the following conditions.
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1. Obstructed labor: It is an important cause of


rupture. Its mechanism is described in details
above .It is usually a complete lateral uterine
rupture in the lower segment but also extends into
the upper segment
2. Multiparity: Uterine wall weakness in grand
multiparas can cause uterine rupture in early
labor. It is usually a complete rupture involving
upper segment.
3. Oxytocic and prostaglandins can also cause
spontaneous rupture of uterus.
SCAR RUPTURE :
Scar rupture is the most common cause of rupture in
developed countries. Dehiscence is defined as the
separation along the line of the previous scar. Rupture is
said to occur if the unscarred tissue is also involved in the
separation, membranes are also ruptured and there is
bleeding from the margins.
During pregnancy :
Classical caesarean or hysterectomy scar is more likely
to rupture during late pregnancy due to the following
reasons:
1. The reason is that the healing of scar is poor and
defective due to its situation in upper contractile
segment of the uterus/
2. The wound approximation is less perfect due to
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` Thick myometrium.
3. The placenta may be located more commonly in
the upper segment scar making it weak.
4. The upper segment stretches more during
pregnancy.
During labor:
The classical or hysterectomy scar is more likely to give
way in labor. Lower segment scar mostly rupture involves
both upper and lower segments with more symptoms and
early shock.
IATROGENIC OR TRAUMATIC UTERINE
RUPTURE:
During pregnancy :
Injudicious amd unmonitored use of oxytocic on
Pregnant uterus.
1. Injudicious use of prostaglandins on a pregnant
uterus.
2. Difficulty and forced external cephalic version,
especially if performed under general anaesthesia.
3. Abdominal blunt trauma
During labor:
1. Internal podalic version and breech extraction
especially in cases of obstructed labor where
rupture may be imminent.
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2. Destructive surgeries on the fetus.


3. Manual removal of placenta especially in a weak
uterus.
4. Difficult or rotational forceps delivery in
obstructed labor.
5. Injudicious and unmonitored oxytocin infusion for
accelerations of labor.
7. 2 min To explain the DIAGNOSIS:
Diagnosis of Uterine The clinical picture depends on the aetiology of the Student teacher is
Rupture rupture whether complete or incomplete and on the extent explaining, students PPT How we should
of intra-abdominal haemorrhage. are listening. Diagnose the Uterine
Prior to rupture there may be signs of obstructed labor Rupture?
with dehydration ,exhaustion ,tachycardia ,raised
temperature ,tonic contraction and appearance of a
pathological retraction ring which rises higher in the
abdomen. The patient is agony with a dry tongue and
rapid pulse. fetal heart sound may be absent .vaginal
examination may reveal a hot ,dry vagina with a large
caput over the presenting part .this stage is threatened
rupture.
8. 3 min To list down the signs SYMPTOMS : Student teacher is Blackboard What are the
and symptoms of 1. Patient may have sudden severe abdominal pain explaining, students symptoms of Uterine
Uterine Rupture. followed by cessation of pains. are listening and Rupture?
2. She may have a sensation of ‘something giving participating in
way’ discussion.
3. There may be fainting and collapse.
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SIGNS :
1. Non-reassuring fetal status is the earliest sign.
2. Severe pallor
3. Tachycardia
4. Hypotension
5. Abdominal examination
i. Tenderness
ii. Distension
iii. Fetal parts are palpable easily
iv. Free fluid may be present
v. Fetal heart sounds are usually absent.
vi. Uterus and fetus may be felt separate.
6. Vaginal examination reveals –i.hot, dry dry
vagina ii. Recession of the presenting part and
other factors leading to obstructed labor.
7. There may be hematuria if bladder is involved.
9. 4 min To discuss the PREVENTION :
Prevention of Uterine Good antenatal and intranatal care can usually prevent Student teacher is PPT How we can prevent
Rupture. rupture of LSCS scar in majority of cases. explaining, students Uterine Rupture?
1. Early diagnosis and management of cephalopelvic are listening and
disproportion, malpresentation and other factors participating in
leading to obstructed labor. discussion.
2. Proper selection of cases for vaginal birth after
caesarean deliveries.
3. Careful of cases and careful watch during
oxytocin infusion either for induction of labor
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And to avoid their non-judicious use, especially in


multiparas.
4. Avoid all intrauterine manipulation if the liquor
has drained away.There is hardly any place of
internal podalic version in singletone fetus in
present day obstetrics.it should be never done
obstructed labor as an alternative to destructive
operations.
5. Instrumental delivery should be performed only
after all the pre-requisites are fulfilled and on no
account should forceps be applied prior to
complete cervical dilatation.
6. In cases of obstructed labor or threatened rupture,
immediate cesarean delivery should be performed
and all intrauterine manipulations avoided. Even if
the baby is dead, cesarean delivery would
probably be a safer option for the mother.
7. Hospital delivery for high-risk cases,like:
i. Contracted pelvis.
ii. Previous history of caesarean
delivery,hysterectomy or myomectomy
iii. Uncorrected transverse lie.
iv. Grand multiparity.
v. Multiparity with pendulous abdomen.
8. Forced and difficult external cephalic version
especially under general anaesthesia should be
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Avoided.
9. Destructive vaginal operations are either avoided
or should be done by experienced obstetrician
with expertise .after destructive operation; uterus
must be explored to rule out uterine rupture.
10. Manual removal of morbidity adherent placenta
should only be performed gently and carefully by
an experienced obstetrician.
10. 5 min To discuss in detail TREATMENT : Student teacher is PPT What is treatment for
about treatment of 1. Resuscitation with adequate hydration, hemaccel explaining, students Uterine Rupture?
Uterine Rupture. and blood transfusion. are listening and
2. Laparotomy as a definitive treatment. participating in
In acute conditions resuscitation and laparotomy discussion.
are done simultaneously .Two wide bone cannulae
are inserted in two hands.Four units of blood are
to be arranged .Intravenous colloids and
crystalloids are given till blood comes.Intravenous
broad spectrum antibiotics are started.
LAPAROTOMY: Abdomen is opened by vertical
incision and one of the following modalities of
treatment is adopted depending upon the clinical
situation.
HYSTERECTOMY :
Hysterectomy is the preferred operation for rupture uterus
especially in spontaneous rupture due to obstructed labor
with irregular ragged margins. In view of poor general
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Conditions of the patient and disturbed anatomy, a fast


subtotal hysterectomy should be done to avoid injury to
the bladder and ureters.
REPAIR :
The ideal for repair after excision of the fibrous tissue
from margins is the ruptured low segment transverse
caesarean scar because the wound is usually clean.
Repairing a spontaneous obstructive rupture on women’s
request may be complicated by peritonitis and
septicaemia. There is high risk of scar rupture in future
pregnancy. Such patients should be hospitalized early in
their next pregnancy and elective caesarean delivery
performed at 36 weeks or earlier depending on fetal
maturity .The chance of rupture in the subsequent
pregnancy varies from 4-10% Repair of a scar with clean
margins is preferably combined with sterilization if the
woman has children.
11. 2 min To explain the COMPLICATIONS: Student teacher is PPT What are the
complications of Maternal mortality and morbidity are high with rupture explaining, students complications of
Uterine Ruptute. uterus due to haemorrhage, shock and sepsis. The are listening and uterine rupture?
mortality is lowest in LSCS scar rupture, about 1% .The participating in
fetal loss is very high, about 50-70% especially in discussion.
spontaneous or traumatic uterine rupture .Prevention is
better than cure ,must be emphasized.
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NURSING MANAGEMENT
To discuss nursing 1. Monitor for the possibility of uterine rupture.
12. 5 min management of Uterine In the presence of predisposing factors, monitor maternal
Rupture. labor pattern closely for hyper tonicity or signs of
weakening uterine muscle. Recognize signs of impending
rupture, immediately notify the physician, and call for
assistance
2. Assist with rapid intervention.
If the client has signs of possible uterine rupture,
vaginal delivery is generally not attempted. If
symptoms are not severe, an emergency cesarean
delivery may be attempted and the uterine tear
repaired. If symptoms are severe, emergency
laparotomy is performed to attempt immediate
delivery of the fetus and then establish homeostasis.
Implement the following preparations for surgery.
Monitor maternal blood pressure, pulse, and
respirations; also monitor fetal heart tones. If the
client has a central venous pressure catheter in place,
monitor pressure to evaluate blood loss and effects of
fluid and blood replacement. Insert a urinary catheter
for precise determinations of fluid balance. Obtain
blood to assess possible acidosis. Administer oxygen,
and maintain a patent airway.
3. Prevent and manage complications.
Take these steps in order to prevent or limit hypovolemic
shock
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Oxygenate by providing 8 to 10 L/min using a closed


mask. Restore circulating volume using one or more IV
lines. Evaluate the cause, response to therapy, and fetal
condition. Remedy the problem by preparing the client
for surgery and administering antibiotics.
4. Provide physical and emotional support.
Provide support for the client’s partner and family
members once surgery has begun. • Inform the partner
and family how they will receive information about
the mother and new-born and where to wait.
CERVICAL TEAR
The cervix is lacerated in over half of vaginal
deliveries. Most of these are less than 0.5cm. Deep
13. 2 min To explain the cervical cervical tears may be extended to the upper third of
tear. vagina. In rare instances, the cervix may be entirely or Student teacher is PPT What is cervical tear?
partially avulsed from the vagina, with colporrhexis in the explaining, students
anterior, posterior or lateral fornices. Rarely, cervical are listening and
tears may extend to involve the lower uterine segment & participating in
uterine artery & its major branches & even through the discussion.
peritoneum. Cervical lacerations upto 2 cm must be
regraded as inevitable in childbirth. Such tears heal
Rapidly. In healing, they cause a significant change in
round shape of the external os before cervical effacement
& dilatation to that of appreciable lateral elongation after
delivery.
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14. 3 min To enumerate the CAUSES :


causes of Cervical tear. 1. Iatrogenic: Attempted forceps delivery or breech Student teacher is What are the causes
extraction thorough an incomplete dilated cervix. explaining, students PPT of cervical tear?
2. Rigid cervix: This may be congenital or due to are listening and
scarring from previous operations on the cervix. participating in
3. Strong uterine contractions as in precipitate labor. discussion.
4. Extremely vascular cervix as in placenta previa.
5. Detachment of the cervix: Annular detachment of
the cervix may occur following prolonged labor in
primary cervical dystocia.
Partial detachment may occur when the cervix is
Caught between the head and the pelvic wall.
1. Failure to remove a cerclage suture.
2. Congenital elongation of the cervix or What are the signs of
vaginouterine prolapse. cervical tear?
15. 1 min To list down the signs SIGNS: Teacher is explaining chart
of cervical tear. Excessive vaginal bleeding immediately following
delivery in presence of hard and contracted uterus-raises
the suspicion of a traumatic bleeding. Exploration of the
uterovaginal canal under good light not only confirms the
diagnosis but also helps to know the extent of the tear.
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DANGERS :
Early -1.Deep cervical tears involving the major vessels
lead to severe postpartum hemmorahe: 2.Broad ligament
hematoma; 3.Pelvic cellulitis .4.Thrombophlebitis.
Late-1. Ectropion.2.Cervical incompetence with
midtrimester abortion.

16. 2 min To discuss the MANAGEMENT :


management of cervical Only deep cervical tear associated with bleeding should Student teacher is PPT How cervical tear can
tear. be repaired soon after delivery of the placenta .Repair explaining, students be managed?
should be done under general anaesthesia ,in lithotomy are listening and
position with a good light .The pre-requisites are-Sims participating in
posterior vaginal speculum ,vaginal wall retractors ,at discussion.
least two sponge –holding forceps and an assistants

17. 1 min To summarise the topic SUMMARY:


Today we have discussed about the definition, risk Student teacher is
factors, diagnosis, symptoms, complications, treatment explaining
and nursing, management of uterine rupture and cervical
tear.
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CONCLUSION:
18. 1 min To conclude the topic It is concluded that Uterine rupture is a rare, but serious
childbirth complications that can occur during vaginal
birth. It causes a mothers uterus to tear so her baby slips
into her abdomen. This can cause severe bleeding in the
mother and can suffocate the baby.

19. 1 min To list down the BIBLIOGRAPHY :


references. 1. J.B.sharma Midwifery and Gynaecological
nursing .1st edition ,Avichal publications ; page
no.449-460
2. Annama Jacob.A comprehensive Textbook of
Midwifery& gyncecological nursing, 4th
edition,jappee publication; page no369-372.
3. Hiralal konar DC Dutta’s Textbook of
Gynecology.7th edition,Jaypee publication;page
no.398-405
4. https://s3.amazonaws.com/ppt-
download/obstetricinjuriesofgenitalsystem-
151109190042-lva1-app6892.pdf?
5. https://s3.amazonaws.com/ppt-
download/uterinerupture-170221025938.pdf.