Role of Decapitation in Management of A Case of Complete Shoulder Dystocia with Rupture Uterus - A Case Report

2021 ◽  
Vol 15 (11) ◽  
pp. 3043-3044
Author(s):  
Nadia Zahid ◽  
Muntiha Sarosh ◽  
Rakhshsanda Toheed ◽  
Mohammad Saa ◽  
Kokab Zia
Keyword(s):  
Uterine Rupture ◽  
Maternal Education ◽  
Bladder Wall ◽  
Time Lapse ◽  
Shoulder Dystocia ◽  
Maternal Complications ◽  
Fetal Head ◽  
Obstructed Labor ◽  
Uterine Scar ◽  
Scarred Uterus

Complete Shoulder dystocia in the presence of scarred uterus is an acute obstetrical emergency and if not properly handled can lead to serious fetal and maternal complications. A G5P4AO previous II cesarean sections, presented in emergency after delivery of fetal head and impacted shoulders, at a small private clinic in a village, four hours back. On laparotomy, there was uterine rupture from the previous uterine scar along with posterior bladder wall rupture . The shoulder dystocia was relieved by decapitation and breech extraction abdominally. Subtotal hysterectomy and repair of the bladder wall was done. This case highlight the dilemma of lack of regular antenatal care and maternal education, malpractices by untrained health professionals and time lapse in referral system that is still a very serious and major issue in developing countries like Pakistan . Keywords: Shoulder dystocia, obstructed labor, and uterine rupture

scholarly journals Uterine rupture at the fundus during labor: A case report

2021 ◽  
Vol 8 (4) ◽  
pp. 577-579
Author(s):  
Sunita Yadav ◽  
Susheela Chaudhary ◽  
Vani Malhotra
Keyword(s):  
Uterine Rupture ◽  
Early Recognition ◽  
Abdominal Cavity ◽  
Shoulder Dystocia ◽  
Normal Vaginal Delivery ◽  
Maternal Complications ◽  
Predisposing Factor ◽  
Tertiary Hospitals ◽  
Scarred Uterus ◽  
Fundal Pressure

Uterine rupture is a rare but catastrophic complication seen in obstetrical practice. The most crucial predisposing factor is previous caesarean scar and it is generally being reported during labor in patients with scarred uterus. Although rare, rupture of an unscarred uterus is one of the most terrible obstetric complications, resulting in maternal and fetal jeopardy. Shoulder dystocia is one of the most difficult complications of labour that is unpredictable and therefore unpreventable. In neglected cases, grave maternal complications like obstructed labour and rupture of uterus can occur. Very rarely, the reverse, uterine rupture leading to shoulder dystocia can also occur. The present case is reported to emphasize the importance of early recognition of this condition. A 32 year old gravida 5 para 2 live 2 abortion 2 with 9 month period of gestation presented to labor room with shoulder dystocia, with history of fundal pressure. After delivery of head, pain subsided and the trunk failed to deliver. Her previous two deliveries were by normal vaginal delivery 8 years and 5 years back respectively. She had previous two abortions 6 years and 3 years back respectively. Both were spontaneous expulsion followed by dilatation and curettage. On examination, clinical diagnosis of rupture uterus was made and patient was taken up for laparotomy. On laparotomy, fetal body and limbs along with the placenta was seen lying in the abdominal cavity and head was in uterus. Baby of 2.34 kg was extracted as breech. A linear rupture of around 10-12 centimeter was present at fundo-posterior region. Uterus was repaired in 3 layers and bilateral tubal ligation was done. Patient was discharged on post- operative day 10 without any complications.In women with high risk for uterine rupture, delivery must be conducted at tertiary hospitals where facilities for emergency caesarean is available. In these patients, if shoulder dystocia occurs, rupture of the uterus must be suspected as an underlying cause. Assisted fundal pressure during delivery can result in trauma even to the unscarred uterus and cause traumatic uterine rupture. Early diagnosis is vital if maternal morbidity is to be reduced.

scholarly journals Predictive factors of Uterine Rupture

2020 ◽  
pp. 01-05
Author(s):  
Aliou DIOUF ◽  
GUEYE M ◽  
NDIAYE GUEYE ◽  
THIAM O ◽  
MBAYE M ◽  
...  
Keyword(s):  
Risk Factors ◽  
Predictive Factors ◽  
Uterine Rupture ◽  
Demographic Characteristics ◽  
Microsoft Excel ◽  
Obstructed Labor ◽  
Uterine Scar ◽  
Scarred Uterus ◽  
Health Hospital ◽  
Ruptured Uterus

Objectives: To assess the frequency and predictive factors of uterine rupture on no-scar uterus and on scarred uterus in an intermediate level health hospital in Dakar. Method of study: This retrospective was carried out by the Philippe Maguilen Senghor Health Center in Yoff (Dakar) during the period from January 1, 2011 to December 31, 2017. It included all the women who gave birth there'' a single pregnancy after 22 weeks of amenorrhea with a longitudinal fetal presentation or admitted after childbirth. We had studied socio-demographic characteristics and risk factors for uterine rupture. The extracted data was analyzed first on Microsoft Excel 2016 and then on EPI info. Results: Over 7 years, 29,332 deliveries of single pregnancies were recorded in our structure with 54 uterine ruptures, and a frequency of 0.18%. Induction of labor was spontaneous in 47 of the patients who presented with uterine rupture; labor was artificially induced in only 7 patients, with frequencies of 0.17% and 0.36% of all uterine ruptures, respectively. Considering the risk factors of uterine rupture, 5 parameters were discriminating: multiparity (p<0.0001), transfer from another health facility for admission (p<0.0001), type of fetal presentation (p=0.0001), the presence of a uterine scar (p<0.0001) and the age class (p<0.0001). Conclusion: The rate of uterine rupture in our structure is certainly low but should call for more vigilance during labor with a focus on evacuated patients who have started their work in another structure, patients with a uterine scar and multiparous. Childbirth on a scar uterus is a reasonable option after eliminating a potential cause of obstructed labor. Keywords: Ruptured uterus; Scar uterus; Risk factors

scholarly journals RUPTURE OF UTERUS (FUNDUS)

2016 ◽  
Vol 23 (01) ◽  
pp. 114-117
Author(s):  
Mubasher Saeed Pansota ◽  
Aisha Ajmal ◽  
Bushra Sher Zaman
Keyword(s):  
Uterine Rupture ◽  
Past History ◽  
Sudden Onset ◽  
Gravid Uterus ◽  
History Of ◽  
Uterine Curettage ◽  
Rupture Of Uterus ◽  
Uterine Scar ◽  
Scarred Uterus ◽  
Uterine Fundus

Rupture of a gravid uterus is a surgical emergency. Predisposing factorsinclude a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is arare occurrence. We hereby present the case of a spontaneous complete uterine rupture at agestational age of 35 weeks 01 day in a 25 years old patient. The case was managed at theCivil Hospital Bahawalpur. She had past history of one uterine curettage for endometrial polypone year back. She presented with mild abdominal pains of sudden onset. After conservativemanagement for 10 hours in hospital she suddenly developed severe abdominal pains with P/Vbleeding. On ultrasound scan, uterine rupture was diagnosed and an emergency laparotomywas done. The ruptured amniotic sac with baby and placenta were found in the peritoneal cavitywith rupture of the uterine funds. Spontaneous uterine fundus rupture usually occurs whenthere is an upper segment uterine scar. This case report shows that past history of curettage isa risk factor for the presence of uterine scar.

scholarly journals Analyzing uterine rupture: A study from tertiary care centre of western Nepal

2017 ◽  
Vol 4 (3) ◽  
pp. 95-99
Author(s):  
Junu Shrestha ◽  
Rami Shrestha
Keyword(s):  
Uterine Rupture ◽  
Tertiary Care ◽  
Operative Management ◽  
Demographic Variables ◽  
Bladder Injury ◽  
Tertiary Care Centre ◽  
Microsoft Excel ◽  
Cross Sectional ◽  
Uterine Scar ◽  
Scarred Uterus

Background: Rupture uterus is a serious obstetric complication which if diagnosed and managed early improves foetomaternal outcome.Objectives: To determine the frequency, causes, management aspects and foeto-maternal outcome of uterine rupture.Methods: This is a cross sectional observational study conducted in Department of Obstetrics and Gynaecology of Manipal Teaching Hospital from July 2012 to June 2015. All cases of rupture uterus, both complete as well as incomplete, diagnosed during surgery were included. Patient’s demographic variables, clinical presentation, risk factors for rupture were studied. Factors related to rupture like the type, nature and site of uterine rupture were noted. The operative management, maternal and neonatal outcome of the patients was reviewed. All the information was entered in the Microsoft Excel chart sheet. Data was analyzed using simple frequencies and percentages.Results: There were 22 cases of uterine rupture and 7987 deliveries during that period giving frequency of 2.8 rupture uterus in every 1000 deliveries. Uterine scar following previous cesarean section was the commonest (72.7%) cause for rupture uterus. Repair was the commonest (86.4%) surgical treatment done. There was no maternal mortality. Blood transfusion was needed two-third of the cases. Other complications were bladder injury (9.1%), paralytic ileus (9.1%), acute renal failure (4.5%) and pneumonia (4.5%). The perinatal mortality was 45.5%.Conclusion: Uterine rupture is a grave obstetric event with maternal and perinatal morbidity and commonly follows pregnancies with scarred uterus.

Vaginal Birth After Cesarean: Contemporary Update and Ongoing Controversies for the Clinician in the Trenches

2019 ◽  
Author(s):  
Mara Rosner ◽  
Carolyn M Zelop
Keyword(s):  
Uterine Rupture ◽  
Vaginal Birth ◽  
Individual Risk ◽  
Vaginal Birth After Cesarean ◽  
Maternal Complications ◽  
Cesarean Birth ◽  
Trial Of Labor ◽  
Maternal And Neonatal Outcomes ◽  
Uterine Scar ◽  
Uterine Dehiscence

Mounting evidence underscoring serious maternal complications such as hemorrhage, emergent hysterectomy, thromboembolic disease and even death from multiple cesarean deliveries has refocused attention upon trial of labor after cesarean birth.  Research over the last thirty years has provided insight into some of the clinical and demographic factors associated with uterine rupture and successful trial of labor after cesarean delivery. Clinical application of these strategies has the potential to mitigate the dilemma for physicians in the trenches caused by fear of uterine rupture during a trial of labor after cesarean.  Individual risk stratification of candidates that optimizes success and minimizes uterine rupture during a trial of labor after cesarean shows promise for implementation of best practices leading to favorable maternal and neonatal outcomes. This review contains 4 figures, 6 tables, and 97 references. Key Words: Vaginal birth after cesarean (VBAC), Trial of labor after cesarean (TOLAC), uterine rupture, uterine scar, lower uterine segment, repeat cesarean, placenta accreta, uterine dehiscence

scholarly journals Visual Estimation of Force Applied During Simulated Deliveries Complicated by Shoulder Dystocia

2018 ◽  
Vol 08 (04) ◽  
pp. e206-e211
Author(s):  
Margaret Walters ◽  
Allison Eubanks ◽  
Elizabeth Weissbrod ◽  
John Fischer ◽  
Barton Staat ◽  
...  
Keyword(s):  
Study Design ◽  
Pubic Symphysis ◽  
Shoulder Dystocia ◽  
Objective Measurement ◽  
Excessive Force ◽  
Visual Estimation ◽  
Average Amount ◽  
Fetal Head

Background Shoulder dystocia occurs when the fetal head delivers, but the shoulder is lodged behind the pubic symphysis. Training for these emergency deliveries is not optimized, and litigation can occur around a shoulder dystocia delivery. Objective Evaluate the ability of an outside observer to visually estimate the amount of traction applied to the fetal head during simulated deliveries complicated by shoulder dystocia. Study Design Simulated deliveries with an objective measurement of traction were randomly organized for estimation of traction applied. Videos show providers applying a “normal” (75 N) and “excessive” (150 N) amount of force in both a “calm” and “stressed” delivery. Results Fifty participants rated the amount of force applied. Observers estimated traction, on a scale from 1 to 5, higher in the 150-N deliveries as compared with 75-N deliveries (“calm” environment: 3.1 vs. 2.8, p < 0.001; and “stressed” environment: 3.2 vs. 2.8, p < 0.001). Only 15% of observers rated force “above average” or “excessive” in a “calm” environment, as opposed to 30% of observers in the “stressed” environment. Conclusion Observers are not able to determine when “excessive force” is used and are twice as likely to overestimate the force applied to a fetal head when an average amount of force is used and the delivery environment is stressful. Precis Observers are unable to determine when excessive traction is applied to the fetal head during simulated deliveries complicated by shoulder dystocia.

Temporary Erb-Duchenne Palsy Without Shoulder Dystocia or Traction to the Fetal Head

2005 ◽  
Vol 106 (5, Part 1) ◽  
pp. 1110 ◽  
Author(s):  
Robert H. Allen ◽  
Edith D. Gurewitsch
Keyword(s):  
Shoulder Dystocia ◽  
Fetal Head

The ‘occiput-spine angle’: a new sonographic index of fetal head deflexion during first stage of labor as predictor of course of labor and outcome

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hesham Mohammed Fathy ◽  
Ahmed Mohammed Bahaa El-Din ◽  
Haitham Fathy Mohammed ◽  
Mohammed Mahmoud Mohammed Helmy
Keyword(s):  
Maternity Hospital ◽  
Ultra Sound ◽  
Operative Delivery ◽  
Fetal Head ◽  
Obstructed Labor ◽  
Uterine Contractions ◽  
Labor Ward ◽  
Vaginal Deliveries ◽  
Fetal Complications ◽  
First Stage Of Labor

Abstract Background Labor is a physiologic process during which the products of conception (i.e. the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Labor is divided into three stages that include cervical dilatation, fetal delivery and delivery of the placenta. Objective The aims of this study were to quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor and to determine whether a parameter derived from ultrasound examination (the occiput-spine angle) has a relationship with the progress of labor, subsequent effect on maternal, fetal complications and rate of cesarean delivery. Methods This is a prospective cohort study which includes a total of 200 women with gestational age 37-42 weeks were assessed in this study in Ain shams Maternity hospital labor ward by 2 dimensional ultra sound. Examinations were performed after a verbal and written consent from the patient with the patient lying in the dorsal supine position. And exclusion of Occiput-posterior position, multigravida, Indication for cesarean, Medical disorder eg hypertension or diabetes, pre labor rupture of membranes to correlate between the Occiput- spine angle (OSA) and the outcome of labor regarding the progress of labor, incidence of cesarean section, maternal and fetal complications. Results This study demonstrates that the sonographic measurement of the angle formed by the fetal occiput and the spine (occiput-spine angle) is feasible and reproducible, the occiput-spine angle in the first stage of labor is positively correlated with the clinically established station and the risk of obstructed labor requiring an operative delivery ie, Occiput-spine angle have been statistically significantly lower in cases underwent operative delivery. Occiput-spine angle had a statistically significant low diagnostic performance in predicting operative delivery. Conclusion The occiput-spine angle in the first stage of labor correlates significantly with the risk of obstructed labor Compared with spontaneous vaginal deliveries, cases that require obstetric intervention demonstrated a smaller occiput-spine angle at a similar station, suggesting diminished flexion of the fetal head. For occiput anterior fetuses, the greater the degree of fetal head deflexion, the greater risk of operative delivery due to labor arrest.

scholarly journals Determinants of uterine rupture in Dessie Referral Hospital, North East Ethiopia, 2016: case control design

2018 ◽  
Vol 7 (5) ◽  
pp. 1712 ◽  
Author(s):  
Amare Workie ◽  
Yemmiamrew Getachew ◽  
Kibir Temesgen ◽  
Prem Kumar
Keyword(s):  
Caesarean Section ◽  
Rural Areas ◽  
Uterine Rupture ◽  
Case Control ◽  
Previous Caesarean Section ◽  
Obstructed Labor ◽  
North East ◽  
Prolonged Labor ◽  
Dessie Referral Hospital

Background: Uterine rupture remains a major obstetric problem particularly in less developed countries. The aim of this study was to identify determinants of uterine rupture among mothers getting delivery services in Dessie Referral Hospital from January 2016 to June 2016, North East Ethiopia.Methods: A prospective unmatched case control study was conducted recruiting 42 mothers with uterine rupture as case group and 168 for control group. Pretested, structured questionnaire was used to collect data.Results: Descriptive statistics and Logistic regression models were utilized considering 95% confidence interval and p-value of 0.05 to determine the presence and strength of association between dependent and independent variables. Majority (94.2%) of cases came from rural areas, 76.2% had obstructed labor and 55% had prolonged labor. Of 85.7% of cases have reported number of pregnancies ≥ 5. Mothers who encountered obstructed labor and previous Caesarean section scar were at higher risk of uterine rupture (AOR=22.2, 95% CI=2.8-4.1 and AOR=13.6, 95% CI=2.16-17.84 respectively). Mothers living in urban area, having Antenatal Care follow-up, shorter labor stay and primi-parity were found to have lower risk of uterine rupture.Conclusions: This study revealed that living in rural areas, absence of Antenatal Care follow-up, prolonged labor, obstructed labor, grand multiparity and previous Caesarean section scar were determinants of uterine rupture. Viable strategies have to be designed and implemented to tackle these determinants of uterine rupture.

scholarly journals Uterine Rupture with Massive Late Postpartum Hemorrhage due to Placenta Percreta Left Partially In Situ

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Mehmet Coskun Salman ◽  
Pinar Calis ◽  
Ozgur Deren
Keyword(s):  
Uterine Rupture ◽  
Bladder Wall ◽  
Placental Tissue ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Wall ◽  
Placenta Percreta ◽  
Emergency Laparotomy ◽  
Life Threatening

Placental adhesive disorders involve the growth of placental tissue into or through the uterine wall. Among these disorders, placenta percreta is the rarest one. However, it may cause significant complications. This report aimed to report a neglected patient with placenta percreta who developed uterine rupture with life-threatening late postpartum intra-abdominal hemorrhage. On admission, the patient had acute abdomen with moderate abdominal distention and was subjected to emergency laparotomy. A full-thickness defect of the anterior uterine wall involving the hysterotomy site was seen. Placental tissues occupied both sides of the incision and posterior bladder wall was also invaded by placenta. Total abdominal hysterectomy with partial resection of the posterior bladder wall was performed.

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