Uterine rupture surgery in late pregnancy

Uterine rupture refers to a laceration of the uterus or the lower uterus during childbirth or pregnancy, which is a serious complication of obstetrics. Part of it happens in the late stage. Treatment of diseases: uterine rupture uterus contraction is too strong Indication 1. The rupture mouth is neat and easy to suture. 2, rupture to a shorter operation time, no more than 24 hours. 3, no concurrent infection. 4. The uterine artery was not damaged. 5, no uterine malformations. 6, eager to ask for further births Surgical procedure The laparotomy was performed to remove the fetus and hemostasis. The longitudinal midline of the abdomen was removed and the abdominal wall was cut into the abdominal cavity. While the blood side of the abdominal cavity is being explored, if the fetus and placenta have entered the abdominal cavity from the uterus, the fetal foot should be quickly grasped, and the fetus and placenta should be taken out. At the same time, the uterus body directly injects oxytocin or the vein advances oxytocin 20U. To reduce uterine contractions and reduce bleeding. Use an oval clamp or an Alice plier to clamp the rupture to stop bleeding. If a part of the fetus is outside the uterus, it should be extended from the rupture with a pair of scissors to the site where the blood vessels are less, and the fetus is delivered. Use the oval to clamp the uterine wound edge and carefully stop bleeding. Check the ureter, bladder, cervix and vagina for damage. The lower part of the uterus is repaired by transverse rupture. The lower edge of the bladder peritoneum at the lower edge of the free cleft has been shrunk to a deeper part. It is difficult to distinguish from the boundary of the bladder. Carefully find the upper and lower edges of the rupture and lift it with Alice clamp. Lift the bladder with a curved vascular clamp. The peritoneum reflexed to check for bladder damage. And gently push the bladder away from the lower edge of the uterus to avoid injury to the bladder during suturing. If the scar is split, the scar must be trimmed and then sutured. The stitching must be aligned. The first layer was continuously sutured in the whole layer of the No. 2 gut line, and the second layer was continuously sutured and sutured, and the suture was tightened to ensure a good closure. It is best to embed the incision with a bladder reflexive peritoneum. The lower part of the uterus is broken on both sides, and the repair method is broken with the lower part of the uterus, but it is necessary to pay attention to the uterine blood vessels and ureters when suturing. The damage of the ureter is mostly caused by the anatomical relationship, but it is caused by the clamp of the vascular clamp, the operation is mistaken, or it is miscut. If the above injury occurs, it should be discovered in time, and an ureteral anastomosis should be performed immediately. If the blood vessels are formed by puncturing blood vessels during suturing, the serosa should be cut off in time to remove blood and completely stop bleeding. Wide ligament hematoma, the left side of the incision wide ligament hematoma uterus rupture on the side of the uterus, injury to the uterus large blood vessels or branches, forming a large hematoma in the broad ligament). The anterior and posterior lobe of the broad ligament should be opened first, and the ascending uterus artery and its accompanying vein should be ligated to avoid damage to the ureter and bladder. Attachment resection if necessary. If the bleeding is still severe or the hematoma is expanding and no significant bleeding points can be found, internal iliac artery ligation is feasible.