13/07/2025
đ Topic: Uterine Rupture āĻā§, āĻāϰ āϧāϰāύ, āĻāĻžāϰāĻŖāϏāĻŽā§āĻš, āϞāĻā§āώāĻŖ, āĻŦā§āϝāĻŦāϏā§āĻĨāĻžāĻĒāύāĻž, āĻāĻāĻŋāϞāϤāĻž āĻ āĻĒā§āϰāϤāĻŋāϰā§āϧ āϏāĻŽā§āĻĒāϰā§āĻā§ āĻā§āύ⧠āύāĻŋāύ đ
đ´ Uterine Rupture (āĻāϰā§āĻāĻžāĻļāϝāĻŧā§āϰ āĻĢāĻžāĻāϞ) āĻāĻāĻāĻŋ āĻŽāĻžāϰāĻžāϤā§āĻŽāĻ āĻ
āĻŦāϏā§āĻĨāĻž, āϝā§āĻāĻžāύ⧠āĻāϰā§āĻāĻžāĻļāϝāĻŧā§āϰ (uterus) āĻĒā§āϰāĻžāĻā§āϰ āĻšāĻ āĻžā§ āĻāϰ⧠āĻĢā§āĻā§ āϝāĻžāϝāĻŧāĨ¤ āĻāĻāĻŋ āĻŽāĻž āĻāĻŦāĻ āĻļāĻŋāĻļā§āϰ āĻāĻāϝāĻŧā§āϰ āĻā§āĻŦāύāĻā§ āĻā§āĻāĻāĻŋāϰ āĻŽāϧā§āϝ⧠āĻĢā§āϞāϤ⧠āĻĒāĻžāϰā§, āĻŦāĻŋāĻļā§āώ āĻāϰ⧠āĻāϰā§āĻāĻāĻžāϞā§āύ āϏāĻŽāϝāĻŧā§ āĻŦāĻž āĻĒā§āϰāϏāĻŦā§āϰ āϏāĻŽāϝāĻŧāĨ¤
đ´ Definition :
Uterine rupture āĻšāϞ⧠āĻāĻŽāύ āĻāĻāĻāĻŋ āĻ
āĻŦāϏā§āĻĨāĻž, āϝā§āĻāĻžāύ⧠āĻāϰā§āĻāĻžāĻļāϝāĻŧā§āϰ āĻŽāĻžāĻāϏāĻĒā§āĻļā§ āĻ āĻĒā§āϰāĻžāĻā§āϰ āϏāĻŽā§āĻĒā§āϰā§āĻŖāĻāĻžāĻŦā§ āĻāĻŋāĻā§ā§ āϝāĻžāϝāĻŧ āĻŦāĻž āĻĢā§āĻā§ āϝāĻžāϝāĻŧ, āϝāĻžāϰ āĻĢāϞ⧠āĻāϰā§āĻāĻāĻžāϤ āĻļāĻŋāĻļā§ āĻ āĻĒā§āϞāĻžāϏā§āύā§āĻāĻž āĻĒā§āĻā§āϰ āĻāĻšā§āĻŦāϰ⧠(peritoneal cavity) āĻĒā§āϰāĻŦā§āĻļ āĻāϰāϤ⧠āĻĒāĻžāϰā§āĨ¤
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Types :
1. Complete rupture â āĻāϰā§āĻāĻžāĻļāϝāĻŧā§āϰ āϏāĻŦ āϏā§āϤāϰ (endometrium, myometrium, serosa) āĻĢā§āĻā§ āϝāĻžāϝāĻŧāĨ¤
2. Incomplete rupture (dehiscence) â āĻāϰā§āĻāĻžāĻļāϝāĻŧā§āϰ āĻ
āύā§āϤāĻāϏā§āϤāϰ āĻāĻāĻļāĻŋāĻ āĻāĻŋāĻā§ā§ āϝāĻžāϝāĻŧ, āϤāĻŦā§ āĻŦāĻžāĻāϰā§āϰ āϏā§āϤāϰ āĻ
āĻā§āώāϤ āĻĨāĻžāĻā§āĨ¤
â ī¸ Causes :
1. āĻāĻā§āϰ āϏāĻŋāĻāĻžāϰāĻŋāϝāĻŧāĻžāύ āĻ
āĻĒāĻžāϰā§āĻļāύ (Previous Cesarean Section scar)
2. āĻ
āϤāĻŋāϰāĻŋāĻā§āϤ āĻ
āĻā§āϏāĻŋāĻā§āϏāĻŋāύ āĻŦāĻž āĻĒā§āϰāϏā§āĻāĻžāĻā§āϞā§āϝāĻžāύā§āĻĄāĻŋāύ āĻŦā§āϝāĻŦāĻšāĻžāϰ
3. āĻŽāĻžāϞāĻĒā§āϰā§āĻā§āύā§āĻā§āĻļāύ (āĻŦāĻžāĻā§āĻāĻžāϰ āĻā§āϞ āĻĒāĻāĻŋāĻļāύ)
4. āĻ
āϤāĻŋāϰāĻŋāĻā§āϤ āĻĒā§āϰāϏāĻŦ āĻŦā§āĻĻāύāĻž (Obstructed labor)
5. āĻŽā§āĻāĻžāύāĻŋāĻāĻžāϞ āĻā§āϰāĻŽāĻž (forceps, fundal pressure)
6. Grand multiparity (ā§ĢāĻāĻŋāϰ āĻŦā§āĻļāĻŋ āϏāύā§āϤāĻžāύ āĻāύā§āĻŽāĻĻāĻžāύāĻāĻžāϰ⧠āĻŽāĻžā§ā§āĻĻā§āϰ āĻā§āĻāĻāĻŋ āĻŦā§āĻļāĻŋ)
7. āĻĒā§āϰā§āĻŦāĻŦāϰā§āϤ⧠uterine surgery (Myomectomy, D&C āĻāϤā§āϝāĻžāĻĻāĻŋ)
8. āĻŦā§ āϏāĻžāĻāĻā§āϰ āĻļāĻŋāĻļā§ (Macrosomia)
9. Placenta accreta (āĻĒā§āϞāĻžāϏā§āύā§āĻāĻž āĻāϰāĻžāϝāĻŧā§āϰ āĻāĻā§āϰ⧠āĻĸā§āĻā§ āĻā§āϞā§)
10. External trauma (āϝā§āĻŽāύ āĻāĻžā§āĻŋ āĻĻā§āϰā§āĻāĻāύāĻž, āĻāĻāĻžāϤ āĻāϤā§āϝāĻžāĻĻāĻŋ)
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Symptoms & Signs :
1. āĻšāĻ āĻžā§ āϤā§āĻŦā§āϰ āĻĒā§āĻ āĻŦā§āϝāĻĨāĻž
2. Abnormal fetal heart rate (Fetal distress)
3. Vaginal bleeding
4. āĻĒā§āϰāϏāĻŦ āĻŦā§āϝāĻĨāĻž āĻšāĻ āĻžā§ āĻāϰ⧠āĻŦāύā§āϧ āĻšā§ā§ āϝāĻžāĻā§āĻž
5. Absent fetal parts in uterus
6. Palpable fetal parts in abdomen (āĻŦāĻžāĻā§āĻāĻžāϰ āĻ
āĻāĻļ āĻĒā§āĻā§āϰ āĻŦāĻžāĻāϰ⧠āĻ
āύā§āĻāĻŦ āĻāϰāĻž)
7. āĻŽāĻž-āϰ āĻļāĻ-āĻ āĻāϞ⧠āϝāĻžāĻā§āĻž (hypotension, tachycardia)
8. Loss of uterine contour (āĻāϰāĻžāϝāĻŧā§āϰ āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻ āĻāĻ āύ āĻšāĻžāϰāĻžāύā§)
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Diagnosis :
âĒī¸ Clinical assessment
âĒī¸ Continuous fetal monitoring
âĒī¸ Ultrasound (āĻļāĻŋāĻļā§ āĻāϰāĻžāϝāĻŧā§āϰ āĻŦāĻžāĻāϰ⧠āĻāĻā§ āĻāĻŋāύāĻž āĻĻā§āĻāϤā§)
âĒī¸ Laparotomy (āĻā§āĻĄāĻŧāĻžāύā§āϤ āύāĻŋāϰā§āĻŖāϝāĻŧā§āϰ āĻāύā§āϝ āĻāϰāĻžāϝāĻŧā§ āĻā§āϞ⧠āĻĻā§āĻāĻž)
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Emergency Management :
1. āϰā§āĻā§āĻā§ āĻĻā§āϰā§āϤ āϏā§āĻĨāĻŋāϤāĻŋāĻļā§āϞ āĻāϰāĻž (IV fluids, oxygen, vitals monitor)
2. Emergency Laparotomy
3. Fetal delivery (Caesarean section or removal from abdominal cavity)
4. Uterine repair (āĻĢāĻžāĻāϞ āĻā§āĻ āĻšāϞā§)
5. Hysterectomy (āĻāϰā§āĻāĻžāĻļāϝāĻŧ āϏāĻŽā§āĻĒā§āϰā§āĻŖ āĻā§āĻā§ āĻĢā§āϞāĻž, āϝāĻĻāĻŋ repair āϏāĻŽā§āĻāĻŦ āύāĻž āĻšā§)
6. Blood transfusion āĻĻā§āĻā§āĻž āĻšāϤ⧠āĻĒāĻžāϰā§
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Complications :
âĒī¸āĻŽāĻž-āϰ āĻŽā§āϤā§āϝ⧠(Maternal death)
âĒī¸āĻļāĻŋāĻļā§āϰ āĻŽā§āϤā§āϝ⧠(Fetal death)
âĒī¸Massive hemorrhage
âĒī¸Hypovolemic shock
âĒī¸Infertility (āĻŦāĻŋāĻļā§āώāϤ āĻāϰāĻžāϝāĻŧā§ āĻā§āĻā§ āĻĢā§āϞāϞā§)
âĒī¸Infection
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Prevention :
1. Low-risk vaginal delivery āύāĻŋāϰā§āĻŦāĻžāĻāύ
2. āϏāĻ āĻŋāĻāĻāĻžāĻŦā§ labor management āĻāϰāĻž
3. āĻĒā§āϰā§āĻŦāĻŦāϰā§āϤ⧠āϏāĻŋāĻāĻžāϰāĻŋāϝāĻŧāĻžāύ āĻĨāĻžāĻāϞ⧠āϏāϤāϰā§āĻ āĻĒāϰā§āϝāĻŦā§āĻā§āώāĻŖ
4. TOLAC (Trial of labor after cesarean) āĻāϰāϞ⧠āĻāĻžāϞā§āĻŽāϤ⧠monitoring
5. Oxytocin āĻ prostaglandin āĻāϰ āϏāĻ āĻŋāĻ āĻĄā§āĻ āĻ āĻĒāϰā§āϝāĻŦā§āĻā§āώāĻŖ
6. Skilled birth attendant āĻ āĻĒā§āϰāϏāĻŦāĻāĻžāϞā§āύ āĻāϰā§āϰāĻŋ āĻĒā§āϰāϏā§āϤā§āϤāĻŋ āϰāĻžāĻāĻž
đ āĻāĻĒāϏāĻāĻšāĻžāϰ (Conclusion):
Uterine rupture āĻāĻāĻāĻŋ āĻā§āĻŦāύāĻšāĻžāύāĻŋāĻāϰ āĻ
āĻŦāϏā§āĻĨāĻž āϝāĻž āĻĻā§āϰā§āϤ āĻāĻŋāĻāĻŋā§āϏāĻž āĻāĻžāĻĄāĻŧāĻž āĻŽāĻžāϰāĻžāϤā§āĻŽāĻ āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤ āϤāĻžāĻ āĻĒā§āϰā§āĻŦā§āϰ āĻ
āϏā§āϤā§āϰā§āĻĒāĻāĻžāϰ āĻāϤāĻŋāĻšāĻžāϏ, labor management āĻ āĻĢāĻŋāϞā§āĻĄ āĻĒāϰā§āϝāĻžā§ā§ āĻāϰā§āϰāĻŋ āĻā§āϰāĻžāύā§āϏāĻĢāĻžāϰ āϏāĻŋāϏā§āĻā§āĻŽ āĻā§āĻŦāĻ āĻā§āϰā§āϤā§āĻŦāĻĒā§āϰā§āĻŖāĨ¤đ
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