UTERINE RUPTURE AND DEHISCENCE

Uterine rupture refers to separation or tearing, which includes all layers, including serosa, in the uterine wall. It is one of the most dangerous complications that can occur in terms of mother and baby during pregnancy. As a result of excessive bleeding, complications such as maternal and infant deaths, bladder injuries, hysterectomy, neonatal morbidity, intrauterine hypoxia may occur. Uterine rupture, obstructed prolonged labor can be monitored during failed operative deliveries. Uterine rupture during normal delivery often occurs in patients who have had a previous cesarean section. However, due to cesarean or other surgeries, rupture may also occur in the uterus without scar tissue.
In patients who had a previous cesarean section, the incidence of uterine rupture during the next pregnancy has been reported at about 1%. Previously cesarean or myomectomy, etc. In patients without surgery, the incidence of uterine rupture has been reported approximately every 5000-20000. It has been reported to be more common in less developed countries.
Uterine rupture occurs in approximately 1% of patients who have undergone previous cesarean delivery during normal births. There is no consistency in the reported relationships between the time elapsed after cesarean surgery, weight of the fetus, suturing technique of the uterus, maternal age, gestational week and the risk of rupture.
Signs and symptoms:
During uterine rupture, symptoms such as severe abdominal pain, excessive contraction of the uterus or sudden decrease in contraction, vaginal bleeding, non-reactive or deselarative NST, fetal bradycardia, and increased fetal head level can be observed. Vaginal bleeding may not always be present. Even in the presence of severe intraabdominal bleeding, vaginal bleeding may be small. Postpartum bleeding and ongoing pain may be a sign of rupture. Rarely, rupture-related bleeding can occur days or even weeks after birth.
If the rupture is extended to the bladder, findings may accompany hematuria. In a case report, vaginal delivery of a patient who had previously had a cesarean section was performed. Bladder rupture was suspected as a result of severe hematuria after birth. In cystoscopy, it was observed that rupture occurred in the posterior wall of the bladder and the anterior wall of the uterus. Both rupture areas were repaired primarily by laparotomy.
Risk factors for uterine rupture:
- Having had previous operations such as cesarean, curettage, myomectomy, cornual resection
- Multiparite
- Difficult and prolonged labor
- Using medium forceps
- Hyperstimulation
- Polyhydramnios
- Twin, triplet pregnancies
- Trauma
- External version, internal version
- Presipite action (rapid birth)
- Placenta increata, percreata
- Anomalies stretching the lower uterine segment, such as hydrocephalus
UTERINE DEHISENS
Uterine refers to the separation (tearing) in the dehisens uterus, in the area of ​​the old scar incision. The serosa remains intact and is therefore called incomplete uterine rupture. Often hemorrhage and other complications related to mother and baby do not occur. It mostly does not produce clinical symptoms. Uterine dehisens is often seen by chance during cesarean section, and can sometimes be monitored on ultrasonography during pregnancy. In pregnancies having undergone lower segment cesarean section, the rate of dehiscence monitoring during cesarean was found to be around 0.3%. This rate was 2.5% in those who had previous cesarean section with classical vertical incision. Uterine dehiscence can be rarely observed in the first months of pregnancy, even in patients who are not pregnant at the moment but have had a previous cesarean section.
Cases of uterine dehiscence detected in the early weeks of pregnancy have been reported until the fetus becomes viable. In the literature, there are also case reports in the form of dehisens and rupture cases detected in the early weeks of gestation that the fetus is not viable, by performing surgical repair by laparotomy and waiting until 32-34 weeks. In cases of dehisens near Terme, cesarean is applied without waiting because of the risk of rupture.
Treatment and rupture repair:
Since uterine rupture is diagnosed, repair may not be possible in some cases, so hysterectomy may be required, or repair may be performed if the patient's child demand continues. Factors such as the patient's child's request, the size of the rupture area, and the hemodynamic state play a role in this. If the rupture area is repaired, the risk of rupture is high in the next pregnancy (5-20%). Therefore, early planned cesarean is generally recommended in the next pregnancy. If the previously ruptured uterus is in the upper segment (vertical or fundal located), the risk of rupture recurrence is higher. Although there is no complete consensus, cesarean can be planned in some centers by evaluating fetal lung maturity around 35 weeks in these patients. If a rupture from the uterine lower segment has previously occurred, the risk of recurrence is lower, so planned cesarean is usually recommended around 37 weeks.
The dehisens area observed during cesarean is repaired primarily.
Postpartum rupture:
In another case, spontaneous uterine rupture, which occurred 43 days after birth by cesarean, is noted. Subtotal hysterectomy was performed as a result of emergency laparotomy due to bleeding from the subscriber. Although this patient had excessive vaginal bleeding, no intraamdominal bleeding was reported in laparotomy. It has been stated that bleeding may be caused by spontaneous erode of the vessels in the corners of the uterine incision.
In the literature, there are cases of rupture-related bleeding that occur between 7 and 28 days postpartum like this. The bleeding may occur in episodes and sometimes in a period that takes days. Hemorrhages usually occur excessively and painlessly. In this way, it has been reported that postpartum spontaneous rupture and bleeding may be due to endometritis or necrosis.
Cervical laceration (Rupture in the cervix):
Cervical laceration, that is, rupture of the cervix, occurs during normal birth and is usually easily sutured and repaired. It is not necessary to perform laparotomy, that is, opening the abdomen, and it can be repaired from the bottom. It does not cause as bad results as uterine rupture and occurs more often.


Facebook Comments

Subscribe to: Post Comments (Atom)

Popular Posts