DOCSLIB.ORG

The Uterine Rupture and Bladder Rupture on a Pregnant Mother with Previous Cesarean Section After Partum Management on Midwife

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Uterine Rupture and Bladder Rupture on a Pregnant Mother with Previous Cesarean Section After Partum Management on Midwife Proceedings of The 3rd Annual International Conference Syiah Kuala University (AIC Unsyiah) 20 3 In conjunction with The 2nd International Conference on Multidisciplinary Research (ICMR) 20 3 October 2-4, 20 3, Banda Aceh, Indonesia The uterine rupture and bladder rupture on a pregnant mother with previous cesarean section after partum management on midwife Dewi Karlina Rusly1,2, Hilwah Nora2, Kartini Hasballah Department of Obstetrics and Gynecology, Faculty of Medicine, Indonesia University1, Jakarta, 1 43 , Indonesia; Department of Obstetrics and Gynecology, Faculty of Medicine, Syiah Kuala University2, (anda Aceh 23111, Indonesia; Department of Pharmacology, Faculty of Medicine, Syiah Kuala University3, (anda Aceh 23111, Indonesia Corresponding Author: [email protected] Abstract. A-case report about the process and impact of the vaginal birth after section caesarean in rural on a pregnant woman who has previous cesarean. This is the case of Mrs , 30 years old in aterm gestational age with singleton intra partum fetal death, previous cesarean section, with suspected uterine rupture. She was admitted to RSU'A hospital due to unprogress labour, sent from midwife after failed of labour. In the hospital the catether was inserted and we found hematuria. She had been control for pregnancy in the hospital of mother and baby for two times and the last 2 weeks was said the baby still in good condition. She was had the previous cesarean 5 years ago on second pregnancy due to unprogress labour and the incision was transversal, and also had the extraction vaccum history for delivered the first pregnancy. She already get information to delivered this third baby in the hospital, but she was coming to midwife due to contraction, and the orificium uretra extrenum was opened , cm, so the midwife try to delivered the baby for 1 hour, and because failed, the midwife sent to the hospital. After 3 hours, she was administered to the hospital the opened of orificium uteri was 10 cm and we found hematuria. .uring the way she was transferring to hospital she feels the movement of the baby was lost. /hen she administered in hospital the blood pressure was 100010 mm g, with the heart rate 100 times0 minute. She was complaints pain in the previous cesarean scar 3 hours later, and lost of fetal movement since 1 hours ago. 2n ultrasound examination there was intrapartum fetal death. /e decided to do laparotomy exploration due to suspected uterine rupture. 2n the operation we found 200 cc blood clot inside the layer of peritoneum, and after the peritoneum was cleaned and opened we could see the upper of the fetal head out side the uterus which intrapartum fetal death, with the large uterine rupture along the previous cesarean incision about 12 cm length. /e also found the ballon of folley catheter outside the bladder, so we confirm to urology and also found there was a bladder rupture grade I3 with 14 cm lengths on the posterior bladder. After delivered the baby, The uronologist did repair bladder rupture and the bladder was inserted the spolling folley catheter with NaCl 0.97 from the upper bladder for maintenance the drainage of the bladder so it keep clean during in the ward and the folley cateter also inserted from the uretra. The procedure was continued with the obstetrician to do repairation of the uterine rupture. In the ward she was hospitali8ed for 14 days to maintain the bladder. 9rom this case, we would like to assess the patophysiology of uterine rupture and bladder rupture which cause the mortality and morbidity of mother and baby. The uterine rupture has correlation with late and false of management of delivery which result in intra partum fetal death and bladder rupture that was explained in this paper. Key words: Uterine rupture, previous cesarean section, bladder rupture. Introduction ,his is the case of Mrs -, 3 years old in aterm gestational age .ith singleton intra partum fetal death, previous cesarean section, .ith suspected uterine rupture. She .as admitted to RSU0A hospital due to unprogress labour, sent from mid.ife after failed of labour. In the hospital the catether .as inserted and .e found hematuria. She had been control for pregnancy in the hospital of mother and baby for t.o times and the last 2 .eeks .as said the baby still in good condition. She .as had the previous cesarean 1 years ago on second pregnancy due to unprogress labour and the incision .as transversal, and also had the e2traction vaccum history for delivered the first pregnancy. She already get information to 274 Proceedings of The 3rd Annual International Conference Syiah Kuala University (AIC Unsyiah) 20 3 In conjunction with The 2nd International Conference on Multidisciplinary Research (ICMR) 20 3 October 2-4, 20 3, Banda Aceh, Indonesia delivered this third baby in the hospital, but she .as coming to mid.ife due to contraction, and the orificium uretra e2trenum .as opened 8 cm, so the mid.ife try to delivered the baby for 1 hour, and because failed, the mid.ife sent to the hospital. After 3 hours, she .as administered to the hospital the opened of orificium uteri .as 1 cm, and .e found hematuria. During the .ay she .as transferring to hospital she feels the movement of the baby .as lost. 4hen she administered in hospital the blood pressure .as 1 57 mm-g, .ith the heart rate 1 times5 minute. She .as complaints pain in the previous cesarean scar 3 hours later, and lost of fetal movement since 1 hours ago. On ultrasound e2amination there .as intrapartum fetal death. 4e decided to do laparotomy e2ploration due to suspected uterine rupture. On the operation .e found 2 cc blood clot inside the layer of peritoneum, and after the peritoneum .as cleaned and opened .e could see the upper of the fetal head out side the uterus .hich intrapartum fetal death, .ith the large uterine rupture along the previous cesarean incision about 12 cm length. 4e also found the ballon of folley catheter outside the bladder, so .e confirm to urology and also found there .as a bladder rupture grade I7 .ith 14 cm lengths on the posterior bladder. After delivered the baby, ,he uronologist did repair bladder rupture and the bladder .as inserted the spolling folley catheter .ith 8aCl .9% from the upper bladder for maintenance the drainage of the bladder so it keep clean during in the .ard and the folley cateter also inserted from the uretra. ,he procedure .as continued .ith the obstetrician to do repairation of the uterine rupture. In the .ard she .as hospitalized for 14 days to maintain the bladder. From this case, .e .ould like to assess the patophysiology of uterine rupture and bladder rupture .hich cause the mortality and morbidity of mother and baby. ,he uterine rupture has correlation .ith late and false of management of delivery .hich result in intra partum fetal death and bladder rupture that .as e2plained in this paper. Result and Discussion First process occurs .hen patient .ere delivered from Lamno Primary -ealth Care. At 1. , the patient come to mid.ifery and the mid.ife got the cervical opening 8 cm, and the mid.ife .as .aiting for vaginal birth after cesarean.ith inter delivery time 1 years. history since the opening already 8 cm, .ith the e2istence of fetal heartbeat, obtained at 6: to 7: the opening is completed, then by the mid.ife decided to lead, but after a 1 hour .aiting, the baby still .as not born, the mid.ife said parturition .as .asn@t progressed and palpable cord on the baby@s neck. ,hen, at 7.3 , it .as decided to be referred to RSU0A .ith no advanced delivery and cord loops. ,he patient arrived at RSU0A at 9:3 pm then the fetal heartbeat is negative, then urinary catheter is applied, and hematuria .as discovered, and .as also found from anamnesis there .as presence of a previous history of severe pain in long surgical scar that is currently healed. ,here .as suspected uterine rupture, so it is decided to do cito laparotomy e2ploration. Intraoperatively, .e obtained partly uterine rupture .ith fetal head is outside the .omb, and the rupture e2tends in posterior part, .hich is then consulted the urology team. ,hen baby is not born in a breathing condition, and repair performed by a team of Urology Aar rupture and suture the .ound followed by lower uterine segment, peritoneum, and until the .hole abdominal .all. 275 Proceedings of The 3rd Annual International Conference Syiah Kuala University (AIC Unsyiah) 20 3 In conjunction with The 2nd International Conference on Multidisciplinary Research (ICMR) 20 3 October 2-4, 20 3, Banda Aceh, Indonesia ,he Cause of infant death and uterine rupture in these patients are delays in treatment that begins .ith decision errors taken from the patient and patientBs family to deliver at mid.ife at the hospital .hich should have been available OK and delays in treatment .hile at home of mid.ife and it should not try to birth vaginally because there is no available tool for monitoring fetal heart rate and continue operating room at home the mid.ife. Allegations of oxytocin and Kristeller action in these patients has not been established. Uterine rupture is a tear of uterine .all due to passing the .ork of myometrium tension. Uterine rupture is tearing the .all during pregnancy or in childbirth .ith or .ithout tearing the perineum visceral CCunningham, 2 1D. General causes of uterine rupture is a history of surgery to the fundus or corpus uteri, the induction of labor .ith uncontrolled oxytocin, prolonged labor, abnormal presentation Cmainly occur in the lower uterine segment thinningD.
Load more

Recommended publications
  • Placental Abruption
    Placental Abruption Definition: Placental separation, either partial or complete prior to the birth of the fetus Incidence 0.5 – 1% (4). Risk factors include hypertension, smoking, preterm premature rupture of membranes, cocaine abuse, uterine myomas, and previous abruption (5). Diagnosis: Symptoms (may present with any or all of these) o Vaginal bleeding (usually dark and non-clotting). o Abdominal pain and/or back pain varying from intermittent to severe. o Uterine contractions are usually present and may vary from low amplitude/high frequency to hypertonus. o Fetal distress or fetal death. Ultrasound o Adherent retroplacental clot OR may just appear to be a thick placenta o Resolving hematomas become hypoechoic within one week and sonolucent within 2 weeks May be a diagnosis of exclusion if vaginal bleeding and no other identified etiology Consider in differential with uterine irritability on toco and cat II-III tracing, as small proportion present without bleeding Classification: Grade I: Slight vaginal bleeding and some uterine irritability are usually present. Maternal blood pressure, and fibrinogen levels are unaffected. FHR remains normal. Grade II: Mild to moderate vaginal bleeding seen; tetanic contractions may be present. Blood pressure usually normal, but tachycardia may be present. May be postural hypotension. Decreased fibrinogen; with levels below 250 mg percent; may be evidence of fetal distress. Reviewed 01/16/2020 1 Updated 01/16/2020 Grade III: Bleeding is moderate to severe, but may be concealed. Uterus tetanic and painful. Maternal hypotension usually present. Fetal death has occurred. Fibrinogen levels are less then 150 mg percent with thrombocytopenia and coagulation abnormalities.
    [Show full text]
  • Uterine Rupture After Misoprostol Use for Termination of Pregnancy in Second Trimester with Previous Caesarean Section: a Case Report Marjan Ghaemi*
    Case Report iMedPub Journals Critical Care Obstetrics and Gynecology 2018 http://www.imedpub.com/ Vol.4 No.3:14 ISSN 2471-9803 DOI: 10.21767/2471-9803.1000167 Uterine Rupture after Misoprostol Use for Termination of Pregnancy in Second Trimester with Previous Caesarean Section: A Case Report Marjan Ghaemi* Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran *Corresponding author: Marjan Ghaemi, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran, Tel: 0098-912-1967735; E-mail: [email protected] Received date: September 25, 2018; Accepted date: October 16, 2018; Published date: October 22, 2018 Copyright: © 2018 Ghaemi M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation: Ghaemi M (2018) Uterine Rupture after Misoprostol Use for Termination of Pregnancy in Second Trimester with Previous Caesarean Section: A Case Report. Crit Care Obst Gyne Vol.4 No.3:14. cesarean section, hospitalized for severe oligohydramnios with unknown etiology and no history of fluid leakage. In her Abstract previous surgical history, she mentioned laparoscopic cholecystectomy 10 years ago. Considering her medical history Modalities for termination of pregnancy may result in some and normal kidney and bladder in fetal ultrasound, we did not adverse effects especially uterine rupture in women with have proved data for her severe oligohydramnios. Amnio- the previous cesarean section. Here we report uterine infusion was performed to prevent foetal cord compression and rupture in the 23rd week of pregnancy after Misoprostol uses for abortion induction in second pregnancy with the to assess foetal structures.
    [Show full text]
  • Management of Prolonged Decelerations ▲
    OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others.
    [Show full text]
  • Concurrent Intraoperative Uterine Rupture and Placenta Accreta. Do
    Concurrent intraoperative uterine rupture and placenta accreta Romanian Journal of Anaesthesia and Intensive Care 2018 Vol 25 No 1, 83-85 CASE REPORT DOI: http://dx.doi.org/10.21454/rjaic.7518.251.acc Concurrent intraoperative uterine rupture and placenta accreta. Do preoperative chronic hypertension, preterm premature rupture of membranes, chorioamnionitis, and placental abruption provide warning to this rare occurrence? M. Anthony Cometa, Scott M. Wasilko, Adam L. Wendling Department of Anesthesiology, Division of Obstetric Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA Abstract Uterine and placental pathology can be a major cause of morbidity and mortality in the parturient and infant. When presenting alone, placental abruption, uterine rupture, or placenta accreta can result in significant peripartum hemorrhage, requiring aggressive surgical and anesthetic management; however, the presence of multiple concurrent uterine and placental pathologies can result in significant morbidity and mortality. We present the anesthetic management of a parturient who underwent an urgent cesarean delivery for non- reassuring fetal tracing in the setting of chronic hypertension, preterm premature rupture of membranes, and chorioamnionitis who was subsequently found to have placental abruption, uterine rupture, and placenta accreta. Keywords: preterm premature rupture of membranes (PPROM), chorioamnionitis, placental abruption, uterine rupture, placenta accrete, cesarean-hysterectomy Received: 14 March 2018 / Accepted: 30 March 2018 Rom J Anaesth Intensive Care 2018; 25: 83-85 operative bleeding that requires aggressive fluid and blood product management and resuscitation [5]. At present, the literature does not reference the Introduction presentation and anesthetic management of these aforementioned conditions being concurrently present Various placental and uterine pathologies can result in one parturient.
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]
  • A Rare Case of Placenta Percreta Causing Uterine Rupture and Massive Haemoperitoneum in 2Nd Trimester: an Obvious Near Miss
    International Journal of Reproduction, Contraception, Obstetrics and Gynecology Parmar C et al. Int J Reprod Contracept Obstet Gynecol. 2021 Jun;10(6):2495-2497 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20212201 Case Report A rare case of placenta percreta causing uterine rupture and massive haemoperitoneum in 2nd trimester: an obvious near miss Chirayu Parmar*, Mittal Parmar, Gayatri Desai Department of Gynecology, Kasturba Hospital, SEWA Rural, Jhagadi, Gujarat, India Received: 30 December 2020 Accepted: 05 May 2021 *Correspondence: Dr. Chirayu Parmar, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Placenta accreta spectrum is very rarely encountered with ruptured uterus and is commonly seen in third trimester of pregnancy. Hereby, a case of placenta percreta with uterine rupture in second trimester of pregnancy is presented. 40 year old women with previous 2 LSCS presented in emergency department with ninteen weeks pregnancy and massive haemoperitoneum. Emergency laprotomy revealed uterine rupture alnong with placenta percreta for which obstetric hysterectomy was done. Although, a rare occurrence, obstetricians should consider patients placenta accreta spectrum in
    [Show full text]
  • Early Accreta and Uterine Rupture in the Second Trimester
    Open Access Case Report DOI: 10.7759/cureus.2904 Early Accreta and Uterine Rupture in the Second Trimester Joshua A. Ronen 1 , Krystal Castaneda 2 , Sara Y. Sadre 3 1. Internal Medicine, Texas Tech University Health Sciences Center of the Permian Basin, Odessa, USA 2. MS3/Ross University School of Medicine, California Hospital Medical Center, Los Angeles, USA 3. MS4/Ross University School of Medicine, California Hospital Medical Center, Los Angeles, USA Corresponding author: Joshua A. Ronen, [email protected] Abstract The differential diagnosis of third trimester bleeding can range from placenta abruptia to placenta previa to uterine rupture and the placenta accreta spectrum (PAS). However, patients with risk factors such as multiple cesarean sections (c-sections), advanced maternal age (AMA), grand multiparity, and single-layer uterine closure are at greater risk of developing these complications earlier than we would traditionally expect. This case recounts a 38-year-old gravida 6 preterm 3 term 1 abortus 1 live 4 (G6P3114) at 23 weeks and five days gestational age (GA) with a past medical history of preterm pregnancy, pre-eclampsia, chronic abruptia, three previous c-sections, and low-lying placenta who presented to the emergency department (ED) with vaginal bleeding. Initial workup revealed placenta accreta and possible percreta. The patient was placed on intramuscular (IM) corticosteroids in anticipation of preterm delivery. As soon as the patient was stable, she was discharged home. She presented to a different hospital the next day with the same complaints. Imaging was consistent with accreta and her presentation with abruption. During the hospital stay, the patient went into threatened preterm labor (PTL).
    [Show full text]
  • Placenta Percreta Causing Spontaneous Uterine Rupture And
    CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 65 (2019) 65–68 Contents lists available at ScienceDirect International Journal of Surgery Case Reports journa l homepage: www.casereports.com Placenta percreta causing spontaneous uterine rupture and intrauterine fetal death in an unscared uterus: A case report a,∗ b a J.T. Enebe , I.J. Ofor , I.I. Okafor a Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology College of Medicine/Teaching Hospital, Parklane, Enugu, Nigeria b Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Nigeria a r a t b i c l e i n f o s t r a c t Article history: INTRODUCTION: Placenta percreta is a rare; a life-threatening disorder of placentation and one of the Received 31 August 2019 components of the placenta accreta spectrum. It can lead to uterine rupture, an obstetric catastrophe Received in revised form 23 October 2019 that can be associated with increased maternal and fetal morbidity and mortality. Accepted 23 October 2019 PRESENTATION OF CASE: We present an unusual case of spontaneous uterine rupture due to placenta Available online 1 November 2019 percreta in an unscarred uterus of a multiparous woman leading to spontaneous intrauterine fetal death. She presented with hypovolaemic shock following spontaneous rupture of the uterus and subsequent Keywords: intra-peritoneal bleeding. Uterine rupture DISCUSSION: Uterine rupture occurs commonly in a scarred uterus from some form of trauma or injudi- Plcacenta percreta cious use of oxytocics. However, uterine rupture occurring in the absence of prior scar or use of oxytocics Maternal morbidity Intrauterine fetal death is a rarity.
    [Show full text]
  • Obstetric Outcomes in the Second Birth of Women with a Previous
    WALTER RICARDO VENTURA LAVERIANO1 CONNY ELIZABETH NAZARIO REDONDO2 Obstetric outcomes in the second birth of women with a previous caesarean delivery: a retrospective cohort study from Peru Resultados obstétricos no segundo parto em mulheres com uma cesárea anterior: um estudo de coorte retrospectivo no Peru Original Article Abstract Keywords PURPOSE: To examine obstetric outcomes in the second birth of women who had undergone a previous cesarean delivery. Cesarean section/adverse effects METHODS: This was a large hospital-based retrospective cohort study. We included pregnant women who had a previous Delivery, obstetrics delivery (vaginal or cesarean) attending their second birth from 2001 to 2009. Main inclusion criteria were singleton Infant, newborn pregnancies and delivery between a gestation of 24 and 41 weeks. Two cohorts were selected, being women with Pregnancy a previous cesarean delivery (n=7,215) and those with a vaginal one (n=23,720). Both groups were compared and Pregnancy outcome Pre-eclampsia logistic regression was performed to adjust for confounding variables. The obstetric outcomes included uterine rupture, Obstetric labor, premature placenta previa, and placental-related complications such as placental abruption, preeclampsia, and spontaneous preterm delivery. RESULTS: Women with previous cesarean delivery were more likely to have adverse outcomes such as Palavras-chave uterine rupture (OR=12.4, 95%CI 6.8–22.3), placental abruption (OR=1.4, 95%CI 1.1–2.1), preeclampsia (OR=1.4, Cesárea/efeitos adversos 95%CI 1.2–1.6), and spontaneous preterm delivery (OR=1.4, 95%CI 1.1–1.7). CONCLUSIONS: Individuals with Parto obstétrico previous cesarean section have adverse obstetric outcomes in the subsequent pregnancy, including uterine rupture, and Recém-nascido Gravidez placental-related disorders such as preeclampsia, spontaneous preterm delivery, and placental abruption.
    [Show full text]
  • A Case Report of Spontaneous Rupture in Unscarred Uterus
    International Journal of Pregnancy & Child Birth Case Report Open Access A case report of spontaneous rupture in unscarred uterus Abstract Volume 6 Issue 2 - 2020 Background: Uterine rupture is a life-threatening obstetrical complication whose incidence Leandro Torriente Vizcaíno,1 Danelys Cuellar has been increasing. Case: 27 years old patient, gravida two, para one, at 39w3d, referred 2 from a District Hospital severely ill, Glasgow Coma Scale 10/15, BP: 70/42, Pulse: 134, Herrera 1Obstetrics and Gynecology, Mofumahadi Manapo Mopeli Sat: 85% on room air and HB: 3,2g/dl. Ultrasound showed Free fluid in abdominal cavity, Regional Hospital, South Africa uterine rupture, fetus out of the uterine cavity, no fetal heart activity seen. The patient 2Pediatrics, Mofumahadi Manapo Mopeli Regional Hospital, was transferred to the theatre, delivered stillborn male baby, weighing 3221gr. There is South Africa a fundal uterine rupture that was extended until both uterine cornoas. Total Abdominal Hysterectomy was undertaken by Richardson Technique and the patient was discharged Correspondence: Leandro Torriente Vizcaíno, Obstetrics and seven days later. Conclusion: Spontaneous uterine rupture is rare in the unscarred uterus. Gynecologist, Mofumahadi Manapo Mopeli Regional Hospital, However, can happen any time and in any trimester. Phuthaditjhaba, Free State, South Africa, Tel 071-5261738, Email Keywords: abruptio, uterine rupture, unscarred uterus, hysterectomy, trimester Received: February 13, 2020 | Published: March 19, 2020 Abbreviations: IUFD, intrauterine fetal death; SFH, to ICU for hemodynamic control and monitoring. Received blood, symphysis–fundal height; BP, blood pressure; ICU, intensive care plasma and others medication for three days, after that was transfered unit; PNC, postnatal care; TOLAC: trial of labour after cesarean to PNC and discharged four days later in stable condition with BP: delivery 132/81, pulse 78, O2 and Sat: 98%, HB of 11.4g/dl.
    [Show full text]
  • HELLP ME! Maternal Emergencies That Exist Beyond the Laboring Pregnant Patient
    HELLP ME! Maternal Emergencies that Exist Beyond the Laboring Pregnant Patient Presented By: Theresa Bowden CFRN, CCRN, C-NPT Life Flight Network Maternal Emergencies • Hypertensive Disorders of Pregnancy – Preeclampsia, Eclampsia, Gestational Hypertension, Chronic Hypertension • HELLP Syndrome • Amniotic Fluid Embolism • Ante/Postpartum Bleeding • Pregnancy and Trauma Pre-Eclampsia • Defined as: – New onset of hypertension and either proteinuria OR end-organ dysfunction OR both after 20 weeks of gestation in a previously normotensive woman. – * Edema not longer required for this diagnosis. – Can be classified as Mild or Severe Mild Pre-Eclampsia • Blood pressure >140/90 • >300 mg/dL Protein in a 24 hour urine collection Severe Pre-Eclampsia • SBP > 160 or DBP >110 (? recorded on 2 occasions, 6 hours apart) • Proteinuria • ? Oliguria • Visual disturbances • Epigastric pain; Nausea & vomiting • Pulmonary edema • HELLP syndrome • ? Fetal growth restriction Eclampsia • Defined as: – The development of grand mal seizures in a woman with preeclampsia (in the absence of other neurologic conditions that could account for the seizure). Gestational Hypertension • Defined as: – Hypertension without proteinuria or other signs/symptoms of preeclampsia that develops after 20 weeks of gestation. – It should resolve by 12 weeks postpartum. Chronic Hypertension • Defined as: – Chronic/preexisting hypertension is defined as systolic pressure ≥ 140 mmHg AND/OR diastolic pressure ≥ 90 mmHg that antedates pregnancy – OR is present before the 20th week of pregnancy (on 2 occasions) – OR persists longer than 12 weeks postpartum. Complications • Placental abruption • Acute kidney injury • Cerebral hemorrhage • Hepatic failure/rupture • Pulmonary edema • DIC (disseminated intravascular coagulation) • Progression to eclampsia Mortality • In the United States, preeclampsia/eclampsia is one of four leading causes of maternal death – Hemorrhage – Cardiovascular conditions – Thromboembolism – Preeclampsia/eclampsia 1:100,000 live births results in maternal death due to preeclampsia.
    [Show full text]
  • Clinical Recommendations on the Use of Uterine Artery Embolisation (UAE) in the Management of Fibroids
    Clinical recommendations on the use of uterine artery embolisation (UAE) in the management of fibroids Third edition (2013) 2 Contents 1 Summary of recommendations 3 2 Introduction and background 4 3 Literature review 5 4 Indications for fibroid embolisation 8 5 Contraindications 9 6 Subfertile patients and those contemplating a subsequent pregnancy 10 7 Counselling, consent and communication 11 8 Pretreatment assessment and prophylactic measures 12 9 The procedure 13 10 Complications 14 11 The individual’s responsibility in clinical practice 16 12 Follow-up 17 13 Suggested areas for further study 18 14 References 19 Appendix 1. Post-procedure care and management of complications 22 Appendix 2. The working parties 23 3 1. Summary of recommendations 1. The early- and medium-term (to five years) results 5. Patients for UAE should be selected and assessed of uterine artery embolisation (UAE) are good. It is by a multidisciplinary team including a as effective as surgery for symptom control, with the gynaecologist and an interventional radiologist. caveat that about a third of women will require a Direct referral from primary care to an interventional second intervention by five years. radiologist is acceptable, although local governance arrangements should ensure gynaecology input into 2. For women with symptomatic fibroids, UAE should the management of patients referred in this manner. be considered as one of the treatment options Accurate pretreatment diagnosis with MRI is alongside surgical treatments (such as recommended. myomectomy and hysterectomy), endometrial ablation, medical management and conservative 6. The procedure should only be undertaken by measures. radiologists with established competence in embolisation techniques who have undergone 3.
    [Show full text]