Uterine rupture: the road ahead?

Lombaard, Hennie; Rc, Pattinson

doi:10.1007/s11296-006-0042-9

Cited by 3 publications

(3 citation statements)

References 49 publications

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“…Uterine rupture rates in developed countries vary from one in 1000 for scarred uteri to less than one in 10,000 unscarred uteri, with rates in developing countries approximately 10 times higher ( Lombaard and Pattinson 2006 ). The incidence of uterine rupture is 14 times higher in women with uterine scars ( El Joud et al 2002 ).…”

Section: Key Neglected Maternal Morbiditiesmentioning

confidence: 99%

Maternal morbidity: Neglected dimension of safe motherhood in the developing world

Hardee

Blanc

2012

Global Public Health

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In safe motherhood programming in the developing world, insufficient attention has been given to maternal morbidity, which can extend well beyond childbirth. For every woman who dies of pregnancy-related causes, an estimated 20 women experience acute or chronic morbidity. Maternal morbidity adversely affects families, communities and societies. Maternal morbidity has multiple causes, with duration ranging from acute to chronic, severity ranging from transient to permanent and with a range of diagnosis and treatment options. This article addresses six selected relatively neglected aspects of maternal morbidity to illustrate the range of acute and chronic morbidities that can affect women related to pregnancy and childbearing that are prevalent in developing countries: anaemia, maternal depression, infertility, fistula, uterine rupture and scarring and genital and uterine prolapse. Based on this review, recommendations to reduce maternal morbidity include: expand the focus of safe motherhood to explicitly include morbidity; improve data on incidence and prevalence of maternal morbidity; link mortality and morbidity outcomes and programming; increase access to facility- and community-based maternal health care and reproductive health care; and address the antecedents to poor maternal health through a lifecycle approach.

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Section: Key Neglected Maternal Morbiditiesmentioning

confidence: 99%

Maternal morbidity: Neglected dimension of safe motherhood in the developing world

Hardee

Blanc

2012

Global Public Health

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“…Signs and symptoms of UR in labour are fetal heart rate abnormalities, persistent lower-abdominal pain, unusual severe abdominal pain (which will usually break through epidural analgesia), scar tenderness, boggy feeling in the suprapubic region, easy palpation of fetal parts per abdomen, vaginal bleeding, receding of fetal parts on vaginal examination, haematuria, maternal tachycardia, fall in blood pressure, signs and symptoms of haemoperitoneum, cessation of contractions and unusual maternal distress in relation to progress of labour [128]. The most common of these are fetal heart rate abnormalities.…”

Section: Management Of Labourmentioning

confidence: 99%

Current evidence in the management of previous caesarean section: clinical review

Muppala

Najia

2007

Eur Clinics Obstet Gynaecol

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The safety of women undergoing childbirth with prior caesarean delivery is a major public health concern. Most of the earlier studies focused on the success rate of vaginal birth after caesarean section; later focus shifted to maternal and neonatal safety, and presently, each factor that would influence the outcome of trial of labour is being considered on both the success and the safety of vaginal birth following caesarean delivery. The contribution of induction of labour to uterine rupture is not entirely clear. Although large multi-center randomised trials comparing planned elective repeat caesarean delivery vs vaginal delivery following prior caesarean delivery are required for conclusive evidence; current evidence suggests that, in properly selected women, vaginal birth can be safely achieved if adequate facilities to monitor the foetus and immediate caesarean can be performed. Unbiased evidence-based information should be given to patients in making decisions about mode of delivery based on individual characteristics. The purpose of this review is to understand each factor that would influence the success and safety of vaginal birth after caesarean delivery.

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“…The cause of the rupture, the parity and the general condition of the patient, the extent and the site of the tear will all have to be taken into account to determine whether this can be sutured, or instead a subtotal or a total hysterectomy should be performed [16].…”

Section: -Uterine Inversionmentioning

confidence: 99%

Management of severe postpartum haemorrhage: an updated protocol

Amy¹

2006

Eur Clinics Obstet Gynaecol

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Intractable postpartum haemorrhage (PPH) is exceedingly rare. Most complications result from procrastination or lack of adherence to a structured protocol of management. Active management of the third stage of labour is highly effective in preventing PPH. If haemorrhage nevertheless occurs, the following measures are implemented in rapid succession until the bleeding stops: 1) methylergometrine maleate is administered, 2) the uterus is massaged and compressed, 3) oxytocin is infused intravenously, 4) a second intravenous line is installed and blood is drawn for determination of the haematocrit, platelets and coagulation profile, and for cross-matching of blood, 5) a senior obstetrician and a senior anaesthetist are summoned, and the haematologist on call is notified, 6) the patient's condition is monitored to identify any change in her condition, 7) the blood lost is initially replaced by crystalloids, then by packed red blood cells, when available; fresh frozen plasma and platelets are administered at intervals, and cryoprecipitate for correction of hypo-fibrinogenaemia, 8) while the above measures are in progress, the genital tract is examined. Retained secundines, lacerations, placenta accreta, uterine inversion and uterine rupture each require specific treatment. In the absence of these complications and of consumption coagulopathy, persistent bleeding is most frequently due to uterine hypotony. Less often, it originates from the implantation area of a placenta praevia, in which case it can be brought under control by placement of two vertical compression sutures, bringing the anterior and posterior walls of the lower segment in close contact with each other. Treatment of hypotonic haemorrhage consists sequentially of: 1) intramyometrial injection of 15-methyl-prostaglandin F 2 α, 2) rinsing of the uterine cavity with saline at 50°C, 3) inflation of a hydrostatic balloon in the uterus, 4) for bleeding of moderate intensity: selective angiographic catheterisation for either occlusion of the anterior division of the hypogastric arteries with inflatable balloons or embolisation of more distal vessels, 5) for a more severe haemorrhage: transvaginal ligation of the uterine arteries, 6) laparotomy and ligation of the uterine arteries at their lower (if not done transvaginally) and upper ends or, alternatively, of the anterior branch of the hypogastric arteries, 7) alternatively or complementarily, placement of compressive uterine sutures, 8) as last resort, hysterectomy, 9) for persistent bleeding after hysterectomy: tamponade with a pelvic pack, 10) for transportation to the hospital or as a life-saving measure after failure of other treatments: application of an anti-shock garment.

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Uterine rupture: the road ahead?

Cited by 3 publications

References 49 publications

Maternal morbidity: Neglected dimension of safe motherhood in the developing world

Maternal morbidity: Neglected dimension of safe motherhood in the developing world

Current evidence in the management of previous caesarean section: clinical review

Management of severe postpartum haemorrhage: an updated protocol

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