Obstetrics and gynecology. Clinic, diagnosis, treatment for birth trauma (the most important)

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Obstetrics and gynecology. Clinic, diagnosis, treatment for birth trauma (the most important)

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28. Clinic, diagnosis, treatment for birth trauma

Symptoms threatening rupture of the uterus in histopathic genesis: scanty bloody discharge from the genitals, constant pain in the lower abdomen, lower back, weakness of labor, a long period of irregular precursors of contractions (2-3 days).

Symptoms of a threatening rupture of the uterus of mechanical origin: a discrepancy between the size of the fetus and the mother's pelvis. It manifests itself in excessive labor activity, incomplete relaxation of the uterus between contractions. Contractions are sharply painful. The lower segment of the uterus is sharply painful on palpation, there is swelling of the tissue in the bladder area above the pubis, urination is difficult.

Uterine rupture is accompanied by nausea, 1-2 times vomiting, abdominal pain without localization or local in the epigastric region, in the hypogastric or lateral sections, symptoms of peritoneal irritation. On palpation, tenderness is noted with localization in the region of the rupture. When a fetal egg enters the abdominal cavity, parts of the fetus can be palpated. They are located directly under the abdominal wall. The pain increases, the general condition worsens. Violation of the fetus. A woman in labor complains of dizziness, tachycardia, low blood pressure, pale skin, darkening of the eyes, weakness, dry mouth (signs of increasing anemia).

Diagnostics uterine rupture is based on the presence of characteristic symptoms of uterine rupture and history (such as uterine scar after caesarean section, uterine perforation, complications in previous births, weakness of labor forces, bleeding, birth of a large or still fetus, vaginal delivery operations, infection in childbirth and postpartum period). In some cases, women have a burdened gynecological history.

Help Tactics. If symptoms characteristic of uterine rupture occur, the woman must be transported to an obstetric hospital on a stretcher. The woman immediately begins transfusion of any blood replacement solutions in combination with ascorbic acid (3-4 ml of a 5% solution), cocarboxylase (100-150 mg); in case of arterial hypotension, prednisolone (60 mg) or hydrocortisone (150-200 mg) is administered. . The administration of analgesics should be avoided until an accurate diagnosis has been established. In cases of severe shock, the administration of analgesics is acceptable, especially during transport. During transportation, they most often resort to mask anesthesia with nitrous oxide and oxygen in a ratio of 1: 2. However, we should not forget that narcotic analgesics cause depression of the respiratory center and that pregnant women are especially sensitive to their effects.

Treatment of uterine rupture. If the uterus ruptures, a transsection operation is performed and the scope of subsequent actions is determined, regardless of the condition in which the patient is, the presence of a concomitant infection, the nature of the damage, etc. The operation can be aimed at removing the fertilized egg, suturing the rupture, performing amputation or extirpation of the uterus. At the same time, antishock therapy is carried out.

Author: Ivanov A.I.

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