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Prolonged and Obstructed Labor Rupture Uterus PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Prolonged & Obstructed Labor - Rupture Uterus” by Hassan, MD.

This medical PowerPoint presentation is about prolonged and obstructed labor which can lead to a rare but serious complication called uterine rupture. This occurs when the muscular wall of the uterus tears, allowing the contents of the uterus, including the fetus, to spill into the abdominal cavity.

Uterine rupture is more likely to occur in women who have had previous uterine surgery, such as a cesarean section. Other risk factors include a prolonged labor, a large baby, a malpositioned baby, and the use of certain labor-inducing drugs.

Symptoms of uterine rupture include sudden and severe abdominal pain, vaginal bleeding, rapid heart rate, and a decrease in fetal heart rate. If uterine rupture is suspected, an emergency cesarean section is necessary to deliver the baby and repair the uterine tear.

Prevention of uterine rupture involves prompt recognition and management of prolonged or obstructed labor, avoiding unnecessary labor induction, and careful monitoring of women who have had previous uterine surgery.

It is important for women to receive timely and appropriate medical care during pregnancy and childbirth to reduce the risk of complications such as uterine rupture.

Tags : prolonged labor, obstructed labor, uterine rupture, uterus tears, Obstetrics and Gynecology, Obstetrics and Gynecology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 1056 | Downloads : 1

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Slide 1-

Prolonged & Obstructed LaborRupture Uterus
Slide 2-

Prolonged Labor when combined duration of first and second stage of labor (excluding latent phase) is more than 18hrs in primi and >12hrs in multiparous women, is called prolonged labor . Second stage is defined prolonged when it is >2hrs in primi & >1 hr. in multi.
Slide 3-

The prolongation denotes either delay in cervical dilatation and/or inadequate descent of presenting part. Incidence of prolonged labor:- - 8% in primigravda - 2% in multigravida
Slide 4-

Causes of Prolonged Labor Fault in any one or combination of basic elements involved in labor - Fault in power - Fault in passage - Fault in passenger
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Fault in power -Abnormal or Inadequate uterine contraction - Incoordinate uterine contraction - Inability to beardown Fault in passage - Full bladder - Contracted pelvis - Pelvic tumor (e.g.fibroid)
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Fault in passenger -Malposition (op), Malpresentation (Face) - Congenital anomaly of fetus (hydrocephalus) - Deflexed head with poor uterine contraction Others - Injudious early administration of sedative and analgesic before actual labor begins
Slide 7-

Dangers of Prolong Labor Fetal – The fetal risk increased due to combined effect of hypxia & infection Intra uterine hypoxia Low Apgor score at birth Infection Intracranial hemorrage ↑ fetal morbidity & mortality
Slide 8-

Maternal Risks- Maternal distress Postpartum Hemorrhage Trauma to genital tract- cervical tear - Rupture uterus - ↑ operative delivery Puerperal sepsis / Subinvolution Undue stretching of the perineal muscles – which may cause prolapse later ↑ Morbidity and Mortality
Slide 9-

- Use partography in all labor to diagnose abnormality early and timely intervention, optimally by alert and action line. - Early detection of factors producing prolong labor and appropriate timely treatment. Prevention of prolonged labor
Slide 10-

Treatment Evaluate maternal and fetal condition from history, general examination and obstetrical examination and start supportive resuscitation. If there is Fetal Distress in 1st stage of labor, CPD, Malpresentation or failed augmentation → CS If inefficient uterine contraction → Augmentation of labor by ARM and oxytocin.
Slide 11-

Obstructed Labor Definition – Labor is said to be obstructed when inspite of good uterine contraction the progress of labor comes to standstill due to mechanical obstruction. Incidence – 1-5% in referral hospital
Slide 12-

Causes of obstructed labor Important Common causes are:- Contracted Pelvis and CPD Malpresentation ( Shoulder, braw, mentoposteriar) Malposition ( DTA, OP ) Less Common causes are:- Fetal anomalies – Hydrocephalus, fetal ascitis, conjoined twin. Soft tissue tumor –fibroid , ovarian Scarred cervix from previous amputation
Slide 13-

Course of Labor in Obstructed labor During labor uterine contraction increases in intensity, duration and frequency to overcome obstruction With each contraction some retraction of upper segment occur → Upper segment becomes progressively thicker and shorter (tonic contraction) The passive lower segment progressively stretches and become thinner to accommodate the fetus driven from upper segment
Slide 14-

A circular groove is formed between the active upper segment and passive distended lower segment called pathological retraction ring (Bandle’s Ring) In primigravida → further uterine contraction ceases and uterus subsequently becomes inert. In multigravida → the uterus continue to contract vigrously .there is progressive rise of Bandle’s Ring upward and ultimately lower segment rupture if baby is not delivered promptly.
Slide 15-

Clinical features of obstructed labor Patient is in agony due to continuous pain & restless Features of exhaustion – Tachycardia - Perspiration - Dehydration - Ketoacidosis, L. respiration P/A Examination - Bladder may be full - Bandle’s Ring is visible - Upper segment of uterus hard tonically contracted & tender - Lower segment distended & tender - Fetal parts may not be well defined - FHS usually absent or bradycardia
Slide 16-

P/V Examination - Edematous Vulva - Hot and Dry vagina - Offensive vaginal discharge - Cervix almost fully dilated - Membranes are absent - Presenting part may be impacted in pelvis - Cause of obstructed labor is reveals
Slide 17-

Prevention Antenatal detection of high risk pregnancy likely to produce prolong labor such as big size baby, short stature women , CPD, malpresentation & malposition. Routine Partography and timely intervention of a prolonged labor due to mechanical factor can prevent obstructed labor.
Slide 18-

Treatment of obstructed labor Correction of dehydration and acidosis with 1-3 liter NS or RL infusion. Vaginal swab to be taken for C/S Arrange blood in anticipation of PPH. Broad Spectrum antibiotic Obstetrical Management
Slide 19-

Obstetrical Management If baby alive (rare ) → CS If baby is dead - Destructive operation is an option if obstetrician Experience - Otherwise do CS - After Every case of operative vaginal delivery → *vaginal, cervical tear and rupture uterus must be excluded. *Oxytocin must be given * Indwelling catheter for 7-10 days
Slide 20-

Effects of Obstructed Labor Fetus - Asphyxia - Intracranial hemorrhage - Infection - ↑Perinatal Loss Mother Immediate Remote - exhaustion - Genital urinary fistula - Dehydration - rectovaginal fistula - Metabolic acidosis - Variable degree of v.atresia - Genital sepsis - Secondary Amenorrhea due - Injury to G.T. Hysterectomy or Sheehan’s syndrome - PPH & Shock - ↑ M. Morbidity & Mortality
Slide 21-

Rupture Uterus Rupture of uterus is giving way of gravid uterus or dissolution in continuity of uterine wall any time after 28 weeks of gestation with or without expulsion of fetus Rupture of the uterus is one of the most dramatic serous obstetric Emergency. Incidence – Widely varies 1 in 200 to 1in 1800 deliveries
Slide 22-

Aetiology of Rupture Uterus Spontaneous Rupture - Obstructed Labor - Fundal Pressure in grand multipara - Uterine malformation Scar Rupture - Rupture of CS Scar→L.S.C.S-0.2-1.5, U.S.C.S- 4-9% -Uterine scar following operation on uterus *Myomectomy *Metroplasty * Hysterotomy * D&C
Slide 23-

Iatrogenic -Injudicious administration of oxytocin - Use of prostaglandin - Internal version - Destructive operations - Difficult Forceps delivery - M.R.P. Over all most common cause of uterine rupture is separation of previous c.s. scar But in developing country obstructed labor with feto-pelvic disproportion is still one of the common cause of rupture uterus
Slide 24-

Types of Rupture Uterus Complete Rupture- when uterine cavity communicate directly with peritoneal cavity. - Spontaneous rupture is more often complete. Incomplete Rupture- when uterine cavity is separated from peritoneal cavity by visceral peritoneum or broad ligament. - Traumatic is usually incomplete Scar Dehiscence - When there is separation of previous scar with intact peritoneum.
Slide 25-

Site of Rupture Lower segment – Most common occurs in previous CS, obstructed labor, which may extent to lateral site & extends upward. Upper Segment – Occurs in previous classical CS, Previous scar in upper segment & other muscular pathology.
Slide 26-

Diagnosis Rupture During Pregnancy Typically - Acute abdominal pain - Features of shock & intrabdominal hemorrhage - Easily palpable fetal parts - Absent fetal heart sound - Contracted uterus is felt on one side Atypically - Incomplete rupture producing localized abdominal pain & tenderness Frank signs of hemorrhage & shock develop slowly - It may confuse with accidental hemorrhage
Slide 27-

Rupture in Labor H/o vigorous uterine contraction followed by sudden bursting pain→ cessation of L. pains Signs of internal hemorrhage depending on severity → Shock , abdominal tenderness, guarding P/A → Fetal parts are easily palpable together with hard retracted uterus can be felt. Vaginal Examination - Reveals bleeding through the cervical os - Recession of presenting part in complete rupture - Cervix hangs like a curtain - Hematuria may be present
Slide 28-

Management I.V. line, Antibiotics, Arrange blood Laparotomy along with blood transfusion when the ∆ of rupture uterus is made In case of ruptured C.S. scar, low parity, women & rupture wound is clear cut, condition stable →Repair Patient with high parity, edges of rupture are ragged and irregular, anatomy is distorted →Hysterectomy to be.
Slide 29-

Causes of Mortality Hemorrhage Shock Sepsis Mortality in intacted uterus rupture is more than scarred uterus Mortality is more (3%) in classical scar than lower segment scar rupture (1%).
Slide 30-

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