What Is a Uterine Rupture?
Uterine rupture refers to the occurrence of lacerations in the uterine body or lower uterus during childbirth or pregnancy, which is a serious obstetric complication and threatens the lives of mothers and children. Mainly died of bleeding and septic shock. With the improvement of obstetric quality, the incidence of the establishment and gradual improvement of urban and rural health care networks for women and children has decreased significantly. It is rarely seen in urban hospitals, but often in remote rural areas. Uterine ruptures occur most often after 28 weeks of pregnancy and are most common during childbirth. The current incidence is controlled below 1 , the maternal mortality rate is 5%, and the infant mortality rate is as high as 50% to 75% or even higher.
- Uterine rupture refers to the occurrence of lacerations in the uterine body or lower uterus during childbirth or pregnancy, which is a serious obstetric complication and threatens the lives of mothers and children. Mainly died of bleeding and septic shock. With the improvement of obstetric quality, the incidence of the establishment and gradual improvement of urban and rural health care networks for women and children has decreased significantly. It is rarely seen in urban hospitals, but often in remote rural areas. Uterine ruptures occur most often after 28 weeks of pregnancy and are most common during childbirth. The current incidence is controlled below 1 , the maternal mortality rate is 5%, and the infant mortality rate is as high as 50% to 75% or even higher.
Causes of Uterine Rupture
- Uterine rupture mostly occurs in dystocia, dystocia at an advanced age, and parturients who have had uterine surgery or injuries. According to the cause of rupture, it can be divided into scarless uterine rupture and scarred uterine rupture.
- Obstructive dystocia
- Obvious pelvic stenosis is not called the pelvis, soft birth canal deformities, pelvic tumors and abnormal fetal position and other factors prevent the decline of fetal exposure, the uterus to overcome the resistance to strengthen the contraction of the lower segment of the uterus is forced to grow thinner and eventually uterine rupture. This type of uterine rupture is the most common type of uterine rupture, and the rupture occurs in the lower part of the uterus.
- 2. Uterine scar rupture
- The main causes of uterine scars are cesarean section, uterine fibroid ablation, uterine rupture or perforation repair, uterine deformity orthopedics, etc .; the cause of rupture is the mechanical traction of the pregnant uterus leading to rupture of the scar or uterus The endometrium of the scar is damaged, the placenta is implanted, and the penetrating placenta causes the uterus to spontaneously rupture. In recent years, cesarean section has rapidly increased the longitudinal incision of the uterine body. Cesarean section is easy to complicate uterine rupture again. The reason for analysis is that apart from the anatomical properties of the longitudinal section of the uterine body and the transverse incision of the lower section, the role of infection factors must be considered because Patients currently undergoing a cesarean section with a longitudinal uterine body incision usually undergo a long labor cycle, multiple vaginal examinations, and an increased chance of infection.
- 3. Abuse of tocolytics
- The tocolytics here should include various substances that stimulate uterine contraction, including the most commonly used oxytocin (oxytocin) and misoprostol, which has only been used in recent years. The reported cases of misoprostol causing uterine rupture More and more. The main reasons include excessive drug dosage or rapid drug delivery, immature cervix, improper fetal position, obstructive dystocia, and inadequate observation of labor during drug administration.
- 4. Vaginal midwifery surgery injury
- The cervix is not fully opened. Forced forceps or hip traction cause severe laceration of the cervix and extend to the lower part of the uterus. Ignorant lateral inversion, partial destruction of the placenta by fetal destruction, etc. can cause uterine rupture due to improper operation.
- 5. Uterine malformations and dysplasia of the uterine wall
- The most common is a double-horned uterus or a single-horned uterus.
- 6. Lesions of the uterus itself
- Multiple mothers have a history of multiple curettage, a history of infectious abortion, a history of intrauterine infection, a history of artificial stripping of the placenta, and a history of hydatidiform mole. Due to the above factors, the endometrium and even the muscle wall are damaged, and the placenta is implanted or penetrated after pregnancy, which eventually leads to uterine rupture.
Clinical manifestations of uterine rupture
- 1. Bleeding Uterine rupture usually manifests as major bleeding, bleeding is divided into internal bleeding, external bleeding or mixed bleeding. Internal bleeding indicates that blood has accumulated in the broad ligament or in the abdominal cavity, leading to broad ligament hematoma or hemorrhage in the abdominal cavity; external bleeding indicates that blood is discharged from the vagina. Uterine rupture bleeding sites usually include uterine and soft birth canal ruptures and placental detachment. Hemorrhage of the uterus and soft birth canal usually requires damage to the large blood vessels in the area. If the soft birth canal injury does not damage the large blood vessels, it usually does not show large bleeding or activity. Sexual bleeding. The placental bleeding is related to the degree of placental peeling and the strength of the uterine contraction. If the placenta is not completely peeled or is not discharged from the uterine cavity, it will affect the uterine contraction and manifest as a large bleeding; otherwise, if the placenta is completely peeled and has been discharged from the uterine cavity, the uterus will contract Very well, there is a small amount of active bleeding on the detached placenta. The above-mentioned bleeding refers to bleeding before surgery, and bleeding can also be caused after surgery. The main reasons are bleeding from the wound or DIC after clearing of the broad ligament hematoma, or conservative treatment of uterine bleeding. In addition to bleeding caused by hemorrhagic shock, maternal hypercoagulability, excessive bleeding, prolonged shock, and DIC occur.
- 2. Infected sites that are prone to infection after uterine rupture are pelvic, abdominal, retroperitoneal and soft birth canal. The main causes of infection are: the pelvic cavity or the broad ligament communicates with the uterine cavity and the vagina, and bacteria enter after the communication; the uterine rupture is caused by major bleeding, severe anemia or DIC, and the decline in resistance is easy to become infected; Hemorrhage outside the peritoneum is easily infected; hysterectomy or repair after uterine rupture is performed under bacterial conditions; there may be more vaginal operations during diagnosis after uterine rupture; longer uterine rupture is more likely to cause multiple sites Of various infections. In addition, the infection worth mentioning is the respiratory tract infection. There are many factors that cause the infection. The shock and sputum excretion of the normal respiratory tract and the defense mechanism are damaged. At the same time, aspiration cannot be ruled out.
- 3. Injuries leading to uterine rupture of the birth canal and other abdominal and pelvic organs and tissues include injuries before and after surgical intervention. The injuries before the surgical intervention include various injuries of the uterus, lower uterus, cervix and vagina, and there may also be primary bladder injuries due to fetal head compression. Patients with uterine rupture have many injuries during diagnosis and surgical treatment, sometimes even more than the primary injury. Excessive unnecessary vaginal manipulations or examinations during the diagnosis process lead to aggravated birth canal injury; open laparotomy to clean up the accumulated blood or the fetus, placenta, and fetal membranes; improper operation can cause damage to the intestine or greater omentum; clearing the broad ligament Hematomas cause pelvic floor vascular ureteral and bladder damage; uterine rupture takes too long, causing more damage to abdominal organs.
- 4. Impact on the fetus The impact on the fetus after uterine rupture is mainly damage caused by bleeding at different times and to different degrees, and most fetuses die. Perinatal morbidity and mortality of surviving fetuses were significantly increased, and long-term complications were also significantly increased.
Uterine rupture diagnosis
- Diagnosing complete uterine rupture is generally not difficult. Diagnosis can be made based on medical history, delivery history, clinical manifestations and signs. Incomplete uterine rupture can only be found under close observation. Individuals with ruptured late pregnancy can only be diagnosed when symptoms and signs of uterine rupture appear.
- Individual dystocia cases have undergone multiple vaginal examinations and may be infected with peritonitis and present with symptoms similar to uterine rupture. At the time of vaginal examination, because the exposed part of the fetus is still high and the lower part of the uterus is thin, the two fingers touching each other as if only separated the abdominal wall, sometimes it is easy to be misdiagnosed as uterine rupture. It will shrink to the side of the carcass.
Uterine Rupture Treatment
- Found a threatened uterine rupture, effective measures must be taken immediately to inhibit uterine contraction, such as general anesthesia to ether, intramuscular injection of Dingding 100mg, etc., to ease the process of uterine rupture. It is best to perform a cesarean section as soon as possible, paying attention to check whether the uterus has ruptured during the operation. If the fetus is not delivered, even a stillbirth should not give birth to the fetus first through the vagina. This will widen the cleft, increase bleeding, and promote the spread of infection. The dead fetus should be removed quickly by laparotomy. Consider whether there are children, if the uterine fissure is easy to suture, the infection is not serious, and the patient's condition is not good, the fissure can be repaired and sutured. Those with children ligate the fallopian tubes, and those without children retain their reproductive function. Otherwise a total or subtotal hysterectomy is feasible. Those with rupture of the lower uterus should pay attention to check the bladder, ureter, cervix and vagina. If there is any damage, they should be repaired in time.