UTERINE RUPTURE,AMNIOTIC FLUID EMBOLUS

UTERINE RUPTURE   associated with previous uterine scar (in 40% of cases), hyperstimulation with oxytocin, grand multiparity and previou...

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