UTERINE RUPTURE

 

UTERINE RUPTURE

Uterine rupture can be said to have occurred when there is a total disruption of uterine wall with or without the extrusion of the baby or the placenta. It is usually accompanied by bleeding into the peritoneal (abdominal) cavity. The extent of blood loss depends on the part of the uterus and the vessels that were disrupted. It is a monumental disaster that can kill the baby or the mother due to ignorance of the grave danger unskilled childbirth practice pose.

Cessation of uterine contractions can be the first signal of uterine rupture.  A woman shouting from time to time from the pains of strong uterine contractions suddenly feels relief from such contractions. However, such relief is temporary as she is greeted by constant abdominal pain. She can also feel like fainting.

Some women notice vaginal bleeding following uterine rupture. Many may not see any blood in their private parts because a deeply impacted fetal presenting part has effectively walled off the blood in the peritoneal cavity from egress to the vagina.

The doctor can notice that it is easy to palpate fetal parts in a woman whose uterus has ruptured especially when the baby was forcefully extruded from the uterine cavity. The womb can be found contracted down in the abdominal cavity. In such cases the peritoneal covering of the womb (the serosa), the muscle layer, the decidua (inner layer) and the fetal membranes (amnion and chorion) are all disrupted.

Blood can be found in the urine following uterine rupture. This is evidence of the disruption (rupture) of the urinary bladder. However, in obstructed labour, blood can also be found in the urine without uterine rupture because of compression of the bladder by an impacted fetal presenting part. There is interruption of blood flow from the bladder. Some blood vessels can break and release blood into the urine. Outflow of urine is also interrupted and bladder can become swollen from retained urine or oedema

Epigastric pain accompanied by respiratory embarrassment can occur following uterine rupture. It can be due to extrusion of the baby or placenta into the epigastric area (area over the stomach or gaster). The baby impinges on the diaphragm restricting respiratory movements. Blood, liquor or urine that piled up in the paracolic gutters can also flow to the diaphragm restricting respiratory movements