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Zorluk: KolayObstetric Complications

An expectant mother at 38 weeks gestation presents to the obstetric triage unit in active labor. She has a history of a low transverse cesarean delivery three years ago and has opted for a trial of labor for her current pregnancy. Upon admission, her vital signs are stable, and contractions are occurring regularly every 3 minutes. Three hours later, she experiences a sudden, agonizing, tearing pain in her lower abdomen that does not resolve between contractions. Simultaneously, the fetal heart rate tracing demonstrates a prolonged deceleration to 70 beats per minute. A prompt cervical examination demonstrates that dilation is unchanged at 6 cm, but the fetal head has receded from 0 station to -3 station. What is the most appropriate next intervention for this patient?

  1. Immediate laparotomy and delivery of the fetusCevap
  2. B
    Maternal repositioning to the left lateral decubitus position
  3. C
    Initiation of transcervical amnioinfusion
  4. D
    Administration of an intravenous oxytocin infusion
  5. E
    Placement of an intrauterine pressure catheter

Cevap

Immediate laparotomy and delivery of the fetus
The correct response is immediate laparotomy and delivery of the fetus. This patient presents with the classic triad of uterine rupture: sudden tearing abdominal pain, profound fetal heart rate abnormalities (prolonged deceleration), and a pathognomonic loss of fetal station (the fetal head receding upward into the abdomen). Given her history of a prior cesarean delivery, the scar tissue is the weakest point of the uterus and prone to dehiscence during the stress of active labor. Once a rupture occurs, the fetus and amniotic fluid can extrude into the peritoneal cavity, leading to rapid fetal asphyxia and severe maternal intra-abdominal hemorrhage. Emergent exploratory laparotomy is required to deliver the fetus, control the bleeding, and repair the uterine defect.

Adım Adım Çözüm

1
Analyze the patient's obstetrical risk factors.
The patient is undergoing a trial of labor after a previous cesarean delivery.
A prior uterine scar is the single most significant risk factor for uterine rupture during a subsequent labor.
2
Evaluate the acute clinical presentation.
The patient developed sudden tearing pain, a prolonged fetal heart rate deceleration, and a loss of fetal station (retreating from 0 to -3).
The sudden loss of fetal station indicates the presenting part has extruded through the uterine wall into the maternal abdomen, confirming a mechanical rupture.
3
Determine the appropriate management.
The patient requires immediate surgical intervention.
Uterine rupture is a life-threatening catastrophe that causes massive maternal hemorrhage and fetal anoxia, requiring an emergent laparotomy.

Anahtar Kavram

Diagnosis and management of uterine rupture
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Konular

Obstetric Complications

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