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Uterine Rupture - Coggle Diagram
Uterine Rupture
Clinical Features:
Sudden, severe abdominal pain (persists between contractions)
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Significant haemorrhage -> hypovolaemic shock (tachycardia, hypotension, etc)
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Management:
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Circulation:
Assess: cap refill, HR, BP, ECG
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Circulatory resuscitation: blood, IVF
Consider: FFP, platelets and/or fibrinogen
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Surgical management: Caesarean section and the uterus is either repaired or removed (hysterectomy). ?decision-incision interval in operative intervention should be <30mins
Investigations:
CTG: recurrent or late decelerations, prolonges foetal bradycardia are early indicators for uterine rupture
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Ultrasound: abnormal foetal lie or presentation, haemoperitoneuem and absent uterine wall
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Differential diagnosis:
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Vasa praevia – characterised by a triad of ruptured membranes, painless vaginal bleeding, and fetal bradycardia.
Placental abruption – presents with abdominal pain +/- vaginal bleeding. The uterus is often described ‘woody’ and tense on palpation.
Types:
Incomplete: The peritoneum overlying the uterus is intact, the uterine contents remain within the uterus.
Complete: The peritoneum is also torn, and the uterine contents can escape into the peritoneal cavity.
Definition: Refers to a full-thickness disruption of the uterine muscle and overlying serosa. It typically occurs during labour, and can extend to affect the bladder or broad ligament.