产科学英文课件:17 子宫破裂 rupture of uterus.pptx
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,子宫破裂UterineRupture,ShanghaiJiaoTongUniversity,Definition,overalluterinerupturerateof1in1,146pregnancies(0.07%).Uterineruptureinpregnancyisarareandoftencatastrophiccomplicationwithahighincidenceoffetalandmaternalmorbidity.Separationofthemuscularwalloftheuterususuallyoccursduringlaboroccasionallyhappenduringthelaterweeksofpregnancy,Causes,Scarreduterus:
weakscarafterpreviousoperationsontheuterushistoryofcesareansection(VBAC,vaginalbirthafterc-section)myomectomyexcisionofauterineseptumpreviousperforationofuterus(D&C,hysteroscopy,forcepsdelivery,Dystocia:
fetalmacrosomia,contractedpelvisInducedlabor:
withoxytocin,withprostaglandinsObstetricmanagementforcepsuse,IntrauterinemanipulationOthers:
directuterinetrauma(eg,caraccident,fall)violence(eg,gunshot),Types,Incompleterupture:
overlyingvisceralperitoneum(uterineserosa)ispresentcompleterupture:
full-thicknessdisruptionoftheuterinewall,anative,unscarreduterus:
auteruswithasurgicalscar:
(cesareandelivery,uterinerepair,myomectomy),fetaldistress(78%):
prolonged,late,orrecurrentvariabledecelerationsorfetalbradycardiasareoftenthefirstandonlysignsofuterinerupture.diminishedbaselineuterinepressure;lossofuterinecontractility;abdominalpain(5-22%);recessionofthepresentingfetalpart;hemorrhage(11-67%);shock(29-46%);,Symptomsandsigns,1.Ruptureofscar,symptomisveryslightinincompleteruptureabdominalpainwronglyattributedtotheonsetoflaborseverepainandshockoccursincomplete(suddenlypain)fetaldistressbleedinginvagina,2.Spontaneousruptureduringobstructedlabor,prolongedlaborviolentuterineactionspathologicretractionringfetaldistressasharp,tearingpaininlowerabdomenpulserapidbloodpressurefallfetusmaybefeltintheabdominalcavity,Pathologicretractionring:
developsduringlabor.Theringformsatthejunctionoftheactiveupperandtherelativelypassiveloweruterinesegments.,Diagnosis,standardsignsandsymptomsultrasonographycontinuouselectronicfetalmonitoringCTMRIuterinewall:
2-3.5mm,ManagementoftheRupturedUterusThemostcriticalaspectsoftreatment:
atimelydiagnosis;minimizingthetimefromtheonsetofsignsandsymptomsuntilthestartofdefinitivesurgicaltherapy;(10-37mins),Treatment:
immediatestabilizationofthemotherandthedeliveryofthefetusareimperative.TypeofuterineruptureExtentofuterineruptureDegreeofhemorrhageGeneralconditionofthemotherMothersdesireforfuturechildbearing,Prevention:
Multiplepreviouscesareandeliveries;Previousclassicmidlinecesareandelivery;Previouscesareandeliverywithaninterdeliveryintervaloflessthan2years;Previouscesareandeliverywitheitherlaborinductionoraugmentation;Previouscesareandeliveryinawomancarryingamacrosomicfetusweighing4000g;Previousuterinemyomectomyaccomplishedbymeansoflaparoscopyorlaparotomy;,Keynote,Thecausesoftheruptureoftheuterine?
pathologicretractionring?