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UTERINE RUPTURE,AMNIOTIC FLUID EMBOLUS

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UTERINE RUPTURE 
  1. associated with previous uterine scar (in 40% of cases), hyperstimulation with oxytocin, grand multiparity and previous intrauterine manipulation
  2. generally occurs during labour, but can occur prior with a classical incision
Complications

  1. maternal mortality 1-10%
  2. maternal hemorrhage and shock
  3. DIC
  4. amniotic fluid embolus
  5. hysterectomy
  6. fetal distress ---> 50% mortality
Management

  1. immediate delivery for fetal survival
  2. maternal stabilization (may require hysterectomy)

AMNIOTIC FLUID EMBOLUS

Definition

  1. amniotic fluid debris in maternal circulation
  2. rare intrapartum or immediate postpartum complication
  3. 80% mortality
Presentation
  • sudden onset of respiratory distress, cardiovascular collapse and
    coagulopathy
Risk Factors

  1. placental abruption
  2. rapid labour
  3. multiparity
  4. uterine rupture
Treatment : supportive measures, coagulopathy correction


VAGINAL BIRTH AFTER CESAREAN (VBAC)

  1. recommended after previous low transverse incision
  2. success rate varies with indication for previous C-section (generally 60-80%)
  3. risk of uterine rupture (< 1% with low transverse incision)
Contraindications
  1. previous classical, inverted T, or unknown uterine incision, or complete transection of uterus (6% risk of rupture)
  2. history of hysterotomy or previous uterine rupture
  3. multiple gestation estimated fetal weight > 4000 g
  4. non-vertex presentation or placenta previa
  5. inadequate facilities or personnel for emergency C-section

UTERINE RUPTURE,AMNIOTIC FLUID EMBOLUS UTERINE RUPTURE,AMNIOTIC FLUID EMBOLUS Reviewed by Radiology Madeeasy on January 15, 2011 Rating: 5
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