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Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth. Risk factors are prolonged labour, dystocia, grand multiparity, previous caesarean section, previous myomectomy and excessive amounts of uterotonics.
Cesarean section and vaginal birth after cesarean section
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The risk of uterine rupture in patients undergoing TLCS varies with the type of previous uterine incision and the number of previous cesarean sections. The risks of uterine rupture range from 0.6% to 0.9% with one previous low transverse uterine incision (19,28,53,54,63–66), 0.7% to 1.8% with more than one previous low transverse uterine incision (53,54,56,57), and is about 12% with a previous classical uterine incision (59). Other predisposing factors include excessive amount of intravenous oxytocin for augmentation or induction of labor, and dysfunctional labor. Fetal macrosomia and epidural anesthesia do not appear to increase the risk of uterine rupture (27). Signs of uterine rupture include abdominal pain, vaginal bleeding, abnormal labor, and abnormal FHR patterns such as sudden onset of prolonged fetal bradycardia and severe variable decelerations (18,67). Trial of labor in patients with previous cesarean sections does not increase maternal mortality compared with those undergoing elective cesarean section (59).
Uterine Rupture
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
The early diagnosis and treatment of uterine rupture are pivotal to a successful outcome. The early involvement of a senior obstetrician, an anaesthesiologist, a neonatologist and a transfusion medicine specialist forms an essential part of management. The aims of management are resuscitation (discussed in Chapter 14) and laparotomy followed by repair of the uterine tear (with or without tubal ligation) or hysterectomy. Verbal consent for either of the surgical interventions should be obtained from the woman. The urgency of the situation necessitates general anaesthesia to be administered.
Uterine rupture after high-intensity focused ultrasound ablation of adenomyosis: a case report and literature review
Published in International Journal of Hyperthermia, 2023
Yinxia Liu, Na Fu, Bin Lv, Yuedong He, Xiaoli Wang
The preferred gestational age for delivery and indications for vaginal delivery or cesarean section remain controversial. However, various studies have indicated the safety of vaginal delivery in women with previous HIFU treatment [8,9]. Based on our experience, patients with unplanned pregnancies after aggressive HIFU treatment should reduce activities in late pregnancy and live close to the hospital in case of medical emergencies. Pelvic MRI during the third trimester may be helpful for evaluating the thickness of the uterine wall, particularly the ablated area by HIFU treatment. It is necessary to admit to hospital when uterine contractions were observed. Inexplainable abdominal pain and fetal intrauterine distress could be signs of uterine rupture. After delivery to the fetus and placenta, the entire uterus, specifically the areas receiving HIFU treatment, should be carefully examined for local weakness or rupture.
How to boost an obstetrician's confidence in vaginal delivery after high-intensity focused ultrasound: a comparison study on delivery outcomes
Published in International Journal of Hyperthermia, 2022
Jinping Gu, Bin Lin, Zhengyu Guo, Aixingzi Aili
Before we get into the delivery mode after HIFU, let's take a look at the delivery modes after myomectomy and cesarean section, because they appear to have the same ‘scarred uterine’ comparability. Vaginal delivery after myomectomy is controversial because the incidence of uterine rupture in women who experienced a trial of labor after myomectomy was 0.03–0.47% [20]. As a result, treatment options for patients with uterine fibroids who want to try vaginal delivery after myomectomy are limited. The American College of Obstetrics and Gynecology (ACOG) now recommends an elective cesarean section for women who have had a previous myomectomy in which the endometrial cavity was entered [21,22]. Over a century ago, women who had previously had a cesarean section were advised to have elective caesareans in all subsequent pregnancies, based on the view of the time, as exemplified by phrase ‘once a cesarean, always a cesarean’. This viewpoint has since shifted, tempered by emerging safety evidence balancing the risk of uterine rupture against the risks of multiple cesarean sections and taking women's preferences into account. Trial of labor after cesarean delivery (TOLAC) is a preferred method for pregnant mothers with no contra-indications for vaginal delivery now [23,24].
Hypogastric artery ligation in postpartum haemorrhage: a ten-year experience at a tertiary care centre
Published in Journal of Obstetrics and Gynaecology, 2021
Mehmet Sait İçen, Fatih Mehmet Findik, Gamze Akin Evsen, Elif Ağaçayak, Senem Yaman Tunç, Mehmet Sıddık Evsen, Talip Gül
Patients who gave birth at the Dicle University Faculty of Medicine Clinic of Gynaecology and Obstetrics and who underwent BHAL because of PPH following a conservative treatment between January 2007 and December 2017, and patients referred our clinic from external centres for the management of PPH, were included in this study. Patients who delivered before 20 weeks of gestation and those who underwent BHAL for gynaecological reasons were excluded from the study. Hypogastric arteries were ligated at a point 4 cm distal to the bifurcation of the common iliac artery. Placental abnormalities are normally classified under three groups according to the extent of the uterine invasion as accreta, increta and percreta, all of which are referred to as placenta accreta in this study (Evsen et al. 2012b). As stated Rauf et al. placenta accreta was diagnosed using greyscale, colour and 3D power Doppler ultrasonography before operation; the intraoperative findings suggested the fragmentary or difficult separation of the placenta (Rauf et al. 2017). In patients with uterine rupture, it was determined that rupture repair was performed first. It was found that uterine artery ligation was performed primarily in patients with uterine atony. Firstly, active suturing of the placental bed was done on placenta accreta cases. In cases where bleeding continues, BHAL was done.