Rupture of a uterine tube

Description:

Rupture of a uterine pipe - the terrible complication of an extrauterine pregnancy which is followed by an acute pain and the phenomena of hemorrhagic shock, posing a threat for life.

Symptoms of the Rupture of a uterine tube:

The acute clinical picture of a disease is characteristic of a rupture of a uterine tube. Suddenly, sometimes at an exercise stress or the act of defecation, at the patient there comes the bad attack of pain in the bottom of a stomach with irradiation in a rectum, there are a cold sweat, pallor of integuments, there comes the short-term loss of consciousness, a lowering of arterial pressure. Pulse becomes weak and frequent. Frenikussimpty positive if in an abdominal cavity there are not less than 500 ml of blood, symptoms of irritation of a peritoneum appear. The condition of the patient is caused by hemorrhagic and painful shock.

In side departments of a stomach the dullness is defined (free blood in an abdominal cavity). The stomach is blown moderately up, unsharply expressed muscle tension of a front abdominal wall and morbidity of lower parts of a stomach are noted, is more often on the party of a rupture of a pipe. At a gynecologic research (it should be seen off extremely carefully in order to avoid repeated painful shock, strengthening of bleeding and a collapse) insignificant increase in a uterus usually is defined, its palpation and the movements of a neck of uterus are sharply painful. Tumorous formation of a pasty consistence without accurate contours is defined by a side vault of the vagina in the field of appendages.

The back arch is flattened or is even stuck out in a vagina. The palpation of the back arch is sharply painful. From the cervical channel soon after an attack there are insignificant dark and bloody allocations (during the first hours they can be absent). In several hours after a pain attack from a uterus decidual fabric which represents almost full mold of a cavity of the uterus begins to be torn away. The condition of the patient can be stabilized for some time or even to improve, but in process of increase in internal bleeding the picture of a heavy collapse and shock develops. Weight of a condition of the patient is caused by blood loss volume, however at the same time ability of adaptation of the patient to blood loss is of great importance.

Informative diagnostic test is кульдоцентез by means of which availability of free blood in an abdominal cavity can be confirmed. The blood received at a puncture has dark color, contains soft clots and does not turn that distinguishes it from the blood received from a blood vessel (blood of scarlet color with bystry formation of clots). If as a result of a puncture through the back arch blood is not received, then it does not reject yet the diagnosis of an extrauterine pregnancy as perhaps wrong performance of a puncture or lack of blood in pozadimatochny deepening in view of commissures and unions in a small pelvis. The hemoperitoneum is the indication for an immediate surgery. The rupture of a pipe is a relative contraindication for organ-preserving operation. Hemorrhagic shock of the II—III degree is the indication to a laparotomy. Due to the above the choice of access of an operative measure at a rupture of a uterine tube depends on a condition of the patient.

Reasons of the Rupture of a uterine tube:

At a rupture of a uterine tube (at a periods delay on average on 3–4 weeks) as a result of disturbance of an extrauterine pregnancy of a fiber of fetal egg completely destroy a thin wall of a uterine tube and blood from the damaged vessels streams in an abdominal cavity.

Treatment of the Rupture of a uterine tube:

Operative measure at an outside rupture of a fruit bed usually consists the struck pipe at a distance. At recently occurred rupture of a pipe an operative measure is very simple. After opening of a peritoneum blood from an abdominal cavity begins to pour out. The section of a peritoneum is expanded, enter a hand into a pelvic cavity, grope a uterus, then the changed appendages and remove them in a wound, at the same time in a wound the uterus corner, and then and its bottom is shown. At small durations of gestation when usually the rupture of a pipe also meets, it is often so poorly increased that to the touch it can and be not noticed.

At big durations of gestation the pipe together with an ovary is defined in the form of a softish tumor of bigger or smaller size. If in a wound the pipe in which there is no pregnancy is by mistake removed, then it is lowered in an abdominal cavity and take the second.

Most often the rupture of a pipe in its isthmic part which is represented increased in this place meets. On a pipe wall most often there is a small opening from which chorion fibers act. Sometimes the thickening of a pipe does not exceed the sizes of a pea, the uzura of its wall is insignificant and only attentive survey allows to see the specified changes.

Having examined a pipe and having made sure that in it pregnancy developed, impose one Kocher's forceps or the plug on a pipe at the corner of a uterus. At the same time in a clip occupy also the small site of a mesentery of a pipe. It is necessary to watch that the end of a clip did not take own ligament of an ovary. The following clip is imposed on мезосальпинкс at the ampullar end of a pipe parallel to it. Мезосальпинкс until the end of a clip make cuts, and then impose 1 — 2 clip on the rest of a mezosalpinks and delete a pipe. It is inexpedient to take in one clip all мезосальпинкс as at deligation the average site, the mezosalpinks taken in a clip can slip out or the gentle mesentery of a pipe is cut through. It creates an unreliable hemostasis which can not be followed by bleeding at the time of operation because of low blood pressure, and will be shown further. Clips replace with catgut ligatures. Especially carefully it is necessary to impose a ligature on the uterine end of a pipe as differently it can easily slide off. Best of all, imposing a ligature, to cut away a pipe stump, carrying out a seam from above at an uterine fundus and under the end of a clip.