B Y

M A G D Y A B D E L R A H M A N M O H A M E D

2 0 1 5

OBSTETRIC INJURIES

Rupture uterus.

Cervical & vaginal tears.

Perineal injuries.

RUPTURE UTERUS

More common with high parity. Why??

Etiology

I-Rupture during pregnancy.

Spontaneous

Uterine scar ( most common).

Rudementary horn at 4th or 5th m.

Incarcerated RVF.

External trauma.

Cont.

II- Rupture during labour.

Spontaneous

Obstructed labour.

Uterine scar.

Traumatic

Forceps.

Internal podalic version.

Destructive operations (historical).

Types of rupture

Complete.

Dehiscent scar.

Predisposing factor for scar weakness

Site: upper segment.

Bad coaptation of edge.

Poor hemostasis.

Infection.

short pregnancy interval after CS.

Clinical picture

History of prolonged labuor.

Picture of obstructed labour.

Vital signs

Abdominal examination.

Easily felt fetal part

Uterus felt away from fetus

Vaginal bleeding

Dehiscent scar ??

Diagnosis

C/P

U/S

Fetal bradycardia or death.

Fetus away from uterus.

Differential diagnosis

Concealed accidental Hge.

Advanced abdominal pregnancy.

Prevention

Early diagnosis of obstructed labour.

Proper use of ecbolics.

Careful intrauterine manipulation.

Treatment

Resuscitation.

Exploration.

Repair site of rupture if possible.

Check integrity of the bladder ….. Repair any tear.

Hysterectomy is life saving in some situations.

CERVICAL TEARS

Predisposing factors.

Instrumental deliveries.

Rapid dilatation of cervix.

Scarring of cervix.

Complications

Post partum Hge.

Upward extension to lower uterine segment.

Cervical incompetence. (delayed)

Diagnosis

Examination under anaesthesia.

Hold ant & post lips by ring forceps.

Treatment

Correction of general condition.

Immediate repair.

You should reach the apex of tear.

PERINEAL TEARS

Degree.

1st degree

2nd degree

3rd degree

4th degree

Etiology

Overstretch of perineum

Malposition

Extention of head before crowning.

Large head

Narow subpubic angle

Forceps.

Rapid stretch of perineum

Precipitate labour

Rigid or scared perineum

Iatrogenic.

Complication

Bleeding.

Infection.

Delayed.

Anal incontinence.

Rectovaginal fistula.

Treatment

Anatomical repair under anaesthesia

Preferred within 24 hour.

Aftercare:

In case of 4th degree

3 days nothing per mouth then 3 days oral fluid.