RUPTURE OF THE UTERUS
DEFINITION: Disruption in the continuity of the all uterine layers (endometrium, myometrium and serosa) any time beyond 28 weeks of pregnancy is called rupture of the uterus. Small rupture to the wall of the uterus in early months is called perforation either instrumental or perforating hydatidiform mole. Rupture of a rudimentary pregnant horn has got a special clinical entity and is grouped in ectopic pregnancy.
INCIDENCE: The prevalence widely varies from 1 in 2,000 to 1 in 200 deliveries. During the past few decades, the prevalence has been found to be almost static. Whereas improved obstetric care reducesthe rupture from obstructed labor but there has been increased prevalence of scar rupture following increased incidence of cesarean section over the years.
ETIOLOGY: - The causes of rupture of the uterus are broadly divided into:
- Spontaneous Scar Rupture.
During pregnancy: It is indeed rare for an apparently uninjured uterus to give way during pregnancy.
The causes are:
1) Previous damage to the uterine walls following dilatation and curettage operation or manual removal of placenta.
2) Rarely in grand multiparae due to thin uterine walls.
3) Congenital malformation of the uterus (bicornuate variety) is a rare possibility.
4) In Couvelaire uterus Spontaneous rupture during pregnancy is usually complete, involves the upper segment and usually occurs in later months of pregnancy. On rare occasions spontaneous rupture may occur even in early months.
During labor: Spontaneous rupture which occurs predominantly in an otherwise intact uterus during labor is due to:
Obstructive rupture: This is the end result of an obstructed labor. The rupture involves the lower segment and usually extends through one lateral side of the uterus to the upper segment.
Non Obstructive rupture : Grand multiparae are usually aff ected and rupture usually occurs in early labor. Weakening of the walls due to repeated previous births as mentioned earlier may be the responsible factor. Th e rupture usually involves the fundal area and is complete.
SCAR RUPTURE: With the liberal use of primary cesarean section, scar rupture constitutes significantly to the overall incidence of uterine rupture. The incidence of lower segment scar rupture is about 1–2%, while that following classical one is 5–10 times higher. Uterine scar, following operation on the non-pregnant uterus such as myomectomy or metroplasty hardly rupture as the wound heals well because the uterus remains quiescent following operation. Uterine scar following hysterotomy behaves like that of a classical scar and is of growing concern.
During pregnancy: Classical cesarean or hysterotomy scar is likely to give way during later months of pregnancy. The weakening of such scar is due to implantation of the placenta over the scar and consequent increased vascularity. Right angle stretching effect by the increased transverse diameter of the enlarging uterus puts an additional effect in disruption of the upper segment scar. Lower segment scar rarely ruptures during pregnancy.
During labor: The classical or hysterotomy scar or cornual resection for ectopic pregnancy is more vulnerable to rupture during labor. Although rare, lower segment scar predominantly ruptures during labor.
IATROGENIC OR TRAUMATIC
1) Injudicious administration of oxytocin.
2) Use of prostaglandins for induction of abortion or labor.
3) Forcible external version especially under general anesthesia.
4) Fall or blow on the abdomen.
1) Internal podalic version-especially following obstructed labor.
2) Destructive operation.
3) Manual removal of placenta.
4) Application of forceps or breech extraction through incompletely dilated cervix.
5) Injudicious administration of oxytocin for augmentation of labor.
HOMOEOPATHIC MEDICINES FOR MANAGING RUPTURE OF UTERUS: -
Some of the commonly used Homoeopathic remedies for Uterine fibroids are: -
- Aurum Mur natronatum
- Calcarea Carb
- Lycopodium clavatum
- Pulsatilla pratensis
- Sepia officinalis
- Thuja Occidentalis.
- Homoeopathic remedies can easily manage these uterine rupture complications and their Recurrence