tailieunhanh - obstetrics_part3

Nếu vỡ là hoàn toàn có nghĩa là, nếu nó liên quan đến độ dày của bức tường tử cung và tử cung có bản chất nổ, vỡ vài giờ, và nhiễm trùng ối là rõ ràng thực hiện phẫu thuật cắt bỏ tử cung tổng phụ interadnexal. | 2. Bleeding during pregnancy 2 15a Uterine wall during contraction 15b Impending rupture hourglass uterus Bandl s ring Figures 15 Abdominal palpation of uterine contour for diagnosis of impending rupture For the laparotomy a subumbilical midline incision is preferable better exposure sometimes with periumbilical extension. If the rupture is complete-that is if it involves the full thickness of the uterine wall and the uterus has essentially burst the rupture is several hours old and amniotic infection is apparent-perform interadnexal subtotal hysterectomy. If the rupture is complete but the tear is well-defined limited recent does not involve significant bruising of surrounding tissue and there is no apparent amniotic infection attempt repair. The tear is usually in the lower segment anterior and low. To extract the child enlarge the tear as for a caesarean section. Before suturing the uterine muscle it may be necessary to neaten the edges of the tear. Depending on the extent of the lesions and the obstetrical history discuss tubal ligation. For a lateral lower segment rupture dissect the broad ligament to look for damage to the uterine artery which must be sutured. If the rupture is incomplete that is subperitoneal the peritoneum is elevated by a haematoma that must be dissected. Check the integrity of the bladder. This is trial version 43 Bleeding during the second half of pregnancy Causes of bleeding during the 2nd half of pregnancy summary Placenta praevia Abruptio placentae Uterine rupture History - Twin pregnancy - Caesarean section - Bleeding during a previous pregnancy - Pre-eclampsia - Primipara - Long labour - Primipara - Dystocia - Grand multipara 6 - Caesarean section - Overuse of oxytocin Clinical signs Bleeding - Bright red blood - Painless bleeding spontaneous or after vaginal exam or sexual intercourse - Bleeding without warning sign - Light flow of blackish blood or sudden bright red bleeding - Bleeding accompanied by severe .