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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.
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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` 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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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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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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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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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.
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.