COLPORRHEXIS
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Transcript of COLPORRHEXIS
Rupture of vaginal vault or upper third of vagina occurring during labor most commonly follows an extension of a tear of the lower uterine segment .
Maybe spontaneous or traumatic in origin
Rupture of the upper vagina follows on an extension of a tear of the cervix results from unskillful, sometimes brutal attempts at fetus delivery by instrumental
Especially when incompletely dilated following internal version, forceps extraction and breech extraction the cervix – injured
Less often rupture of lower uterine segment follows intra-uterine manipulations with laceration into vaginal vault with injury – bladder and leads to hematuria
Misdirection of the uterine axis due to extremely pendulous abdomen associated with marked divarication of recti abdominis muscle.
* Sudden descent of presenting part at
the commencement of the 2nd labor stage, the pressure against posterior
vaginal vault will increase with greater tendency to injury.
Following ventrofixation of uterus * Previous ventrofixation to
ant.abdominal wall would retard development of ant. uterine wall, uterus growing at expense of post. wall which is thinner and weaker
Previous weakening of vaginal wall * Rupture of post. vaginal wall in its upper
limits leads to greater tendency to laceration during parturition . * Previous scarring following operations on
post. vaginal wall – laceration in labour.
Parity * Multiparity
Most frequent oblique and occasionally encircling entire lower uterine segment/vagina
Sometimes –injury is vertical when lateral wall of vagina involved
Vagina may be separated from cervix by transverse tear; extends down lateral wall
Rupture of upper vagina with probable rupture of uterus was diagnosed :
Sudden cessation of labor painsSudden onset shock signs of blood loss Extreme pendulousness of abdomen
Presented for those of rupture of uterus (even if not severe)
Multiparity patients – Primary Colporrhexis had extremely pendulous abdomens
Cessation of labor pain followed by continuous abdominal pain
Vaginal bleeding occurs ( slight amount to profuse hemorrhage)
Signs of shock
Bowel / Omentum may escape into vagina
Peritonitis may supervene if diagnosis is not made
Death may result from hemorrhage/ infection if operation not performed