Page 1 : ic HAEMATOMA 20K, , tion of blood anywhere in the area between the pel, elvic, Pe, , vic haematoma., 4 ted rupt S, } as mentioned later in the chapter,, , skin is called pel ‘4, TYPES: Depending upon the, , a whether below or ‘, , ) RUPTURE OF THE UTERUS, , Jocation of the haematoma,, above the levator am, it is termed as:, , « Infralevator haematoma — common, « Supralevator haematoma — rare, , INFRA LEVATOR HAEMATOMA :, onest one is the vulval haematoma., , , , proad ligament peritoneum is in, are tobe secured and ligated Random Be, zing continues, one may h :, ure uterus may mi, , d and the blood clot, ind sutures should ni, , 2 the, he anterior division of, atment, , t is scoo, ped out. The, au Placed to prevent, internal iliac artery, , , , , , DEFINITION = Collec, , , , continuity of the uterine wall any ti, ry to the wall of the uterus in early n, mole. Rupture of a rudimentary y, , tion in the ¢, , , , e beyond 28 w., , eeks of pregnan, months is called enantio: ts, prey honk, Pregnant hom has got a special clinical, , , , nce widely varies from 1in 2000 to 1 in 20¢ eries. During th, , found to be almost static. Whereas improved obstetric care an BS aN ee, , re has been increased prevalence of scar rupture following in fie Se oe, e fo creased incidence of, , The comm, , , , ) Improper haemostasis during, repair of vaginal or perineal tears or episiotomy, wound— (a) Failure to take precaution while, suturing the apex of the tear. (b) Failure to obli, terate the dead space while suturing the vaginal, walls, (2) Rupture of paravaginal venous plexus, either spontaneously or following instrumental, delivery. Fi, Symptoms : (1) Persistent, severe pain on the, perineal region. (2) There may be rectal tenesmus, or bearing down efforts when extension occurs to, the ischio-rectal fossa. There may be even retention of urine., , ETIOLOGY, , f the uterus are broadly divided into :, * SCAR RUPTURE = * IATR', , , , os of rupture ©, » SPONTANEOUS, , , , ive way during pregnancy. The, curettage, involves, , , , indeed rare for an apparently uninjured uterus to, and thereby weakening of the uterine walls fo, moval of placenta. (2) On occasion, no apparent cause is detected and it us, The weakening of the uterine walls results from fibrosis out of bruising, stretching or, muscles in previous Jabours. (3) Congenital malformation of the uterus of bicornuate, y isa rare possibility. (4) In Couvelaire uterus (see p. 256)., spontaneous. rupture during pregnancy is usually complete, involves the upper segment and usually, , s of pregnancy. ‘On rare occasion, spontaneous rupture may occur even in early months., , g labour, , , , , , Signs : (1) Variable degrees of shock ma’ i, ; ry be evident. (2) Local inati, vulva which becomes dusky and purple in colour and tender to tic an ., , fensi, , , , Treatment : 5, en an ae el be treated conservatively with cold, ees 5 ergot serene = a . 7 general anaesthesia. Giuliana (agi esin ater oe, Ferg eaten in cite The dues accor out and the bleeding points are to be oan During labour eponencou? wee oo, space is to be obliterated by deep mattress sutures and adap Site?, , suction drain may be kept i, , pt in that place f. ., Place for 24 hours. Prophylactic antibiotic is to be administered. "+ Obstructive rupture — This is the end res, already been described in p. 362, 405. The rup, one lateral side of the uterus to the upper segment., , + Non-obstructive rupture — Grand multi, , , , ominantly in an otherwise intact uterus duriny, , , , , , , ed labour. The mechanism of rupture has, , ult of an obstruct, ture involves the lower segment and usually extends through, ally occurs in early, msible, , , , SUPRA LEVATOR HAEMAT Causes —, ‘OMA: i, 3s — (1) Extension of cervical laceration or primary colporrhe, , pture). (2) Lower uterine segment rupture (Fig 4 ally affected and rupture ust, , ated previous pirths as mentioned earlier may be the respo!, , , , , , , , (3) Spontaneou: :, WGjcent to the Seat, fee event labour. Weakening of the walls due to repe i I, Diagnosis : The diagnosis is usually late aspitl factor. The rupture usually involves the fundal area and is complete. r, , not of a conspicuous nature and so also the vag SCAR RUPTURE eo, bleeding. Unexplained shock with features of! With the liberal use of primary Caesarean section, scar rupture constitutes a ois, nal haemorrhage following delivery raises thes eof uterine rupture. The incidence oflower segment scar rupture is about ae a ant uterus such 25, picion. Abdominal examination " evel tae cal one is 5-10 times higher. Uterine scat, following operation on a ae remains quiescent, above the inguinal ligament pushing the vend omy or metroplasty hardly rupture aS the wound heals well eee oie, i contralateral side. Vaginal examina! © ip ones P=tation: Uterine scar ostowing hysteratomy behaves IKE that o, , a) occlusion of the vaginal canal by a bug : ; en, boggy swelling felt through the fornix. Rectal a Durin Pregnancy : Classical or hysterotomy scar is likely to give way on 2 ae ent incense, nation corroborates the presence of the bogs " ing of such scar is due to implantation of the placenta over the ie ae vteras pus a, ye pees the increased transverse diameter of ruptures during pregnancy:, of the haematoma. : “Lower segment scat a ve aah, , : 7 ‘ able to ruptur, , eatment Oe The classical or hysterotomy eu pee, , Management : Usual t :, , instituted and arrangement '© mi ptur, , nt scar predominantly ™|