obstetric injuries

Obstetric injuries 18

تسلسل 17
المرحلة الرابعة
نسائية
د.شيماء
العدد8
12\4\2018

The obstetric complication that affects the maternal health includes:-

1.rupture of the uterus
2. acute inversion of the uterus
3.cervical lacerations
4.perineal tears
5.haematomas
6.fistulae
7.Trauma to the pelvic joints and nerves


Rupture uterus
Is the most serious condition.
Can occur during pregnancy or labor

During labour

A.Spontaneous:
1.Obstructed labour.
2.Rupture of a uterine scar.
3.Grand multipara: due to degeneration and overthinning of the uterine muscles.
B.Traumatic:
1.Internal version
2.Manual separation of the placenta.
3.Destructive operations.
4.Extending cervical tear
C.Iatrogenic improper use of oxytocins.









Uterine Rupture :-presented with fetal bradycardia & maternal shock & hemorrhage (often concealed)








Uterine Rupture :-presented with fetal bradycardia & maternal shock & hemorrhage (often concealed)

Uterine inversion

Descent of the uterine fundus into the cavity , cervix or through the vulva it is a very rare event

Aetiology

Conditions that predispose to inversion
1.Fundal implantation of the placenta
2.Abnormal adhesion of placenta(partial placenta accreta)
3.Uterine abnormality
4.Protracted labor
5.Previous uterine inversion
6.Intrapartum therapy with Mg-sulphate
7. Strong traction on umbilical cord
8. Fundal pressure

Diagnosis

Usually obvious
1.Shock& bleeding the patient may be shocked out of all proportion to visible blood loss.
2.Pain
3. bleeding
4.Palpable mass at cervix,vagina or outside
5. Depression in the uterine fundus or even an absent fundus seen on abdominal examination

management

Give uterine relaxant & start manual replacement by gently pushing the fundus

Laceration of the cervix

Minor laceration are very common & usually undetected , deep lacerations need repair under anaesthesia
Which can caused by


Precipitate labor


Forceps application with incompletely dilated cervix


Rapid delivery of head with breech presentation


Previous injury& scar of the cervix

Managment

Prompt recognition of the injury
Control bleeding
Repair under GA

Haematomascan be either

• Vulvar& paravaginal
• 2-Subperitoneal hematomas\broad ligamenthematomas
• Are divided into those above & below the levator muscle
• Infralevator:- vulvar ,perineal, paravaginal&in the ischiorectal fossa
• Supralevator:- spread up ward &outward beneath the broad ligament

Mnagment

either conservative or surgical exploration or hysterectomy according to the site ,size & general condition of the patient for shocked patient

Perineal tears

Tears that affect the perineum happened in different degrees
1st degree : involves only perineal skin
2nd degree :perineal muscle like episiotomy
3rd degree :2nd+disruption of anal sphinicter
4th degree :3rd+torn anal canal

fistulae

May occur as a result of pressure by the presenting part in prolonged labour , or by direct injury during operative procedures
Types
vesicovaginal
rectovaginal

thanks