Symptoms before uterine rupture
summary
Uterine rupture refers to the laceration of uterine body or lower uterine segment during delivery or pregnancy, which is a serious obstetric complication and threatens the life of mother and child. They mainly died of hemorrhage, infection and shock. With the improvement of obstetric quality, the incidence of maternal and child health care network in urban and rural areas has decreased significantly. Urban hospitals have been rarely seen, and rural remote areas have occurred from time to time. The vast majority of uterine rupture occurs after 28 weeks of pregnancy, the most common during delivery. At present, the incidence is controlled below 1 ‰, the maternal mortality rate is 5%, and the infant mortality rate is as high as 50% - 75% or even higher. Let's talk about the symptoms before uterine rupture
Symptoms before uterine rupture
1. Bleeding uterine rupture is usually characterized by massive bleeding, which can be divided into internal bleeding, external bleeding or mixed bleeding. Internal hemorrhage refers to the accumulation of blood in the broad ligament or abdominal cavity, leading to broad ligament hematoma or hemoperitoneum; External bleeding refers to the discharge of bleeding from the vagina. The bleeding sites of uterine rupture usually include uterine and soft birth canal rupture and placental exfoliation bleeding. Uterine and soft birth canal bleeding usually needs to damage the large blood vessels of the location. If the soft birth canal injury does not damage the large blood vessels, it usually does not show massive bleeding or active bleeding. The bleeding of placental exfoliation surface is related to the degree of placental exfoliation and the intensity of uterine contraction; On the contrary, if the placenta is completely stripped and has been discharged from the uterine cavity, and the uterine contraction is good, a small amount of active bleeding will occur on the stripped surface of the placenta. The main causes of bleeding were wound bleeding or DIC bleeding after removal of broad ligament hematoma, or uterine bleeding after conservative treatment. In addition to hemorrhagic shock caused by bleeding, but also due to maternal hypercoagulable state, bleeding, shock time is too long, DIC.
2. The main parts of infection after uterine rupture are pelvic cavity, abdominal cavity, pelvic retroperitoneum and soft birth canal. The main causes of infection are: the pelvic cavity or broad ligament is connected with the uterine cavity and vagina, and bacteria enter after communication; Bleeding after uterine rupture, severe anemia or DIC, decreased resistance, easy to infection; Hematocele in abdominal cavity or pelvic cavity or extraperitoneal hematocele is easy to be infected; After uterine rupture, hysterectomy or repair were carried out under the condition of bacteria; There may be more vaginal operations during the diagnosis of uterine rupture; Uterine rupture with a longer time is more likely to lead to multiple infections. In addition, it is worth mentioning that the infection is respiratory tract infection, which is caused by many factors, such as long shock time, impaired sputum excretion and defense mechanism of normal respiratory tract
3. The damage of the birth canal and other abdominal and pelvic organs and tissues and the damage of uterine rupture include the damage before and after the operation intervention. The injury before operation includes the injury of uterine body, lower uterine segment, cervix and vagina, as well as the primary bladder injury caused by fetal head compression. There are many injuries in the process of diagnosis and surgical treatment of uterine rupture, sometimes even more than the primary injury. Too much unnecessary vaginal operation or examination in the process of diagnosis results in the aggravation of birth canal injury; Improper operation of laparotomy to clean up hematocele or fetal, placental and fetal membranes resulted in intestinal or omental injury; Clear the broad ligament hematoma, causing pelvic floor vascular ureter and bladder injury; Uterine rupture time is too long, the damage to abdominal organs is more serious.
matters needing attention
If necessary, the internal iliac artery or uterine artery should be ligated. If the breach is complex and difficult to repair, hysterectomy should be performed. When suturing or repairing the rupture on the side of uterus or clamping the uterine vessels, we should pay attention not to injure the ureter of the vaginal vault. Serious uterine rupture, should be hysterectomy, but the condition does not allow the use of repair surgery, it is necessary to ligate bilateral fallopian tubes at the same time, in order to prevent recurrence of uterine rupture in pregnancy.
