Page 1 : falkoppin, it, Liealilised, TEXT BOOK OF OBSTET, 430, 431, is, unless major vessels are affected., pregnancies if the uterine rent has been repaired., DIAGNOSIS, one should be conscious of the entity for an early diagnosis., During Pregnancy, abdominal cavity, through the rent in the uterus,, PROPHYLAXIS, • SCAR RUPTURE, • SPONTANEOUS, • IATROGENIC, may be, area with slight vaginal bleeding. There is varying degrees of tenderness on uterine palpation. FHS, irregular or absent. The features may not be always dramatic in nature ("silent phase"). Sooner or later, The at-risk mothers likely to rupture should have mandatory hospital delivery. These are-(a) Contracted pelvis, (D) Previous history of Caesarean section, hysterotomy or myomectomy (c) Uncorrected transverse lie (d) Multiparity, with pendulous abdomen (e) Grand multiparity (f) Known case of hydrocephalus., rupture becomes complete. There is a sense of something giving way accompanied by acute abdominal, derus, and collapse. The diagnosis is self-evident. However, an acute dramatic onset may occur from the beginning, Spontaneous rupture in uninjured uterus-The rupture is usually confined to the high parous women The, onset is usually acute but sometimes insidious. In acute types, the patient has acute pain abdomen with fainting, attacks and may collapse. The diagnosis is established by the presence of features of shock, acute tendemes, on abdominal examination, palpation of superficial fetal parts, if the rupture is complete and absence of fel, heart rate. However, with insidious onset, the diagnosis is often confused with concealed accidental haemo, rrhage or rectus sheath haematoma., - Undue delay in the progress of labour in a multipara with previous uneventful delivery should be viewed with, concern and the cause should be sought for., - General anaesthesia should not be used to give undue force in external version., - Judicious selection of cases and careful watch are mandatory during oxytocin infusion either for induction or, acceleration of labour., - Judicious selection of cases with previous history of Caesarean sections for vaginal delivery (see p. 329)., Rupture following fall, blow or external version or use of oxytocics -There is history of such an acaider, followed by acute pain abdomen and slight vaginal bleeding. Rapid pulse and tender uterus raise the suspa, of rupture. The confirmation is done by laparotomy. This is too often confused with accidental haemormag, nere is hardly any place of internal podalic version in singleton fetus in present day obstetrics. It should never, be done in obstructed labour as an alternative to destructive operation., done ve vaginal operations should be performed by skilled personnel and exploration of the uterus should be, as a routine following delivery., During Labour, D pied forceps delivery or breech extraction through incompletely dilated cervix should be avoided., Scar rupture:, P., is usually acute., TREATMENT, • Laparotomy, following obstructed labour (vide infra) and hence called "silent rupture"., • Resuscitation, Spontaneous obstructive rupture:, is s, Tegion, it is preferable to, jammed in the pelvis and the vagina becomes dry and oedematous., a, INJURIED TO THE BIRTH CANAL, nt pain is changed to dull pain with of (3) examination, the otherfetal (5) (i) of the presenting part and, wof rupture: (1) There is a sense of way at the height of (2) The, e height of is seized with an bursting pain by a relief, jontaneous non-obstructive : is and solely to high parous The patient,, ence of F.H.S., (iii) absence of uterine and (iv) one uterus, assation of contractions. The of the are - of evidences, Sudden of the of the patient with varying of bleeding, s features of and shock. (4) (i) fetal parts,, • : is the surgery for there is reason to pre-, However, if the permits there is a total may be done., Depending upon the state of the is to be done followed by laparotomy, Considering the low and morbid the cervico-vaginal, serve it. This is in rupture, so in the countries., or in acute and are to be done simultaneously., o a rather than Chance of, mims the Not the is not varying intervals following, naring degrees of bleeding., nelopment of shock or or of the cord immediately, Manual in - be done by a person (see p. 420)., fopture following or delivery:, oternal haemorrhage, over the uterus and of vaginal bleeding., LAPAROTOMY: Any of the three may be laparotomy., Scar rupture : or The of a dull pain over the sc The are to or to detect at the earliest the tragic of rupture, lowing a vaginal is of uterine rupture, the being out, wing manipulative or delivery raises the of uterus to feel rent