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Transeverse uterine rupture. Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth. [3] Symptoms, while classically including increased pain, vaginal bleeding, or a change in contractions, are not always present. [1] [2] Disability or death of the mother or baby may result. [1] [3]
In 2015 about 6.5 million cases of obstructed labour or uterine rupture occurred. [5] This resulted in 23,000 maternal deaths down from 29,000 deaths in 1990 (about 8% of all deaths related to pregnancy). [2] [6] [9] It is also one of the leading causes of stillbirth. [10] Most deaths due to this condition occur in the developing world. [1]
Most women in the UK should be counselled to avoid induction of labour if there are no medical reasons for it, as the risks of uterine rupture of the previous scar are increased if the labour is induced. Other intrapartum management options, including analgesia/anesthesia, are identical to those of any labour and vaginal delivery. [9]
Uterine perforation is a potential complication of any intrauterine procedure. It may be associated with injury to surrounding blood vessels or viscera such as the bladder or intestine .
The lower segment becomes stretched and thinner and, if neglected, may lead to uterine rupture. It is a major pathology behind obstructed labor. A circular groove encircling the uterus is formed between the active upper segment and the distended lower segment. Due to pronounced retraction, there is fetal jeopardy or even death.
Surgery may be used if medical management fails or in case of cervical lacerations, tears in the uterine wall or a uterine rupture. Methods used may include uterine artery ligation, ovarian artery ligation, internal iliac artery ligation, selective arterial embolization, B-lynch suture, and hysterectomy.
Sealing membranes after rupture: Infection is the major risk associated with PROM and PPROM. [25] By closing the ruptured membranes, it is hoped that there would be a decrease in infection, as well as encouraging the re-accumulation of amniotic fluid in the uterus to protect the fetus and allow for further lung development.
Obstetrical hemorrhage may be due to a number of factors such as placenta previa, uterine rupture or tears, uterine atony, retained placenta or placental fragments, or bleeding disorders. [71] Puerperal sepsis is an ascending infection of the genital tract. [72] It may happen during or after labour.