DE   EN   ES   FR   IT   PT Obstetrics Hysterorrhesis



Hysterorrhesis – disturbance of integrity of its walls. This hardest complication of pregnancy and childbirth.

Can be spontaneous, arising without external influence, and violent - under the influence of foreign intervention; on a damage rate - full, taking all covers of a wall of a uterus, and incomplete when the gap takes an endometria and a myometrium while remains to perimetry unimpaired.

Hysterorrhesis symptoms:

Symptoms of the menacing gap with accession of the signs indicating an anguish of a uterine wall are inherent to the begun hysterorrhesis: emergence of bloody allocations from a vagina, blood impurity in urine, fruit asphyxia.

The made hysterorrhesis is followed by a typical clinical picture and traditionally does not cause difficulties in diagnosis. At the time of a gap the woman in labor feels severe pain in a stomach, patrimonial activity stops, shock signs are found. The fruit quickly perishes vnutriutrobno, the meteorism, Shchetkin's symptom - Blyumberg are found, from a vagina blood is emitted.

At a fruit vykhozhdeniya in an abdominal cavity the stomach gains irregular shape, through a front abdominal wall small parts of a fruit clearly are palpated. Sometimes the diagnosis of a hysterorrhesis is made late - in an effect of the end of childbirth or for the first days in posledstviirodovy the period that threatens with development of diffuse peritonitis and sepsis. In this regard it is necessary to think of a hysterorrhesis when suddenly are found outside bleeding in an effect of delivery and allocation in a posledstviid at well reduced uterus in the woman in childbirth.

Suspicion on a hysterorrhesis has to arise at a delay in a posledstviid in a uterus and unsuccessfulness of his removal by Krede's method - Lazarevich, in an effect of difficult obstetric operations (outside internal version, fetaldestructive operations). In these cases the manual research of a uterus allows to reveal a gap.

Hysterorrhesis reasons:

Hysterorrheses appear at space discrepancy between the prelying part of a fruit and a basin (a narrow basin, the cross provision of a fruit), extensive and asynclitic insertions of a head (a large fruit, cicatricial narrowings of soft tissues of a parturient canal, tumors of a small pelvis interfering natural delivery). Hysterorrheses are observed also at pathological changes of its wall in connection with inflammatory and dystrophic processes, also on a hem in an effect of Cesarean section or operation of removal of nodes of fibroma.

Treatment of the Hysterorrhesis:

At the menacing and begun hysterorrhesis it will be necessary to stop urgently patrimonial activity by means of deep etherization (the anesthesia should be begun immediately). The woman in labor with the menacing and begun hysterorrhesis is nontransportable. Delivery is carried out on site. The choice of an operational method of delivery depends on an obstetric situation (Cesarean section, fetaldestructive operation).

The made hysterorrhesis demands an immediate chrevosecheniye without preliminary removing the fetus. At the same time hold events for fight against shock and a collapse. The volume of surgical intervention depends on prescription of a gap, signs of presence of an infection, a condition of the broken-off tissues of a uterus, localization of a gap (sewing up of a uterus, supravaginal amputation of a uterus, a hysterectomy).

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