IMMINEN UTERINE RUPTURE

Consultant :
Dr ARVID TARDAN, SpOG

Presented by:
DHEANIRA HEDYASTUTI
030.98.047

Opponent :
EKO SETIAWAN
SISILIA
UGANDA

TRISAKTI MEDICAL FACULTY

Case
I. ANAMNESIS
January 3rd, 2005: 10.00 am

A. Primary Subject
- abdominal discomfort, since January 2nd, 2005
B. History of present illness
- patient: woman 35 years old, come to Hospital with
abdominal discomfort, since January 2nd, 2005
- water breaks (-), bloody show (-)
fetal movement (+), headache (-)
vaginal bleeding (-), oedema extremity (-)
ANC in puskesmas regularly, have high blood
pressure, she is given hypertention drug but she didn’t known the
name of the drug .
Case
B. History of present illness
- patient is given anti hypertension drug but she
didn’t know its name
- she doesn’t want to have a child anymore
C. Menstrual History
- menarche in 13th years old, duration 7 days, 2 – 3 panty liners,
dysmenorrheal (-)
- first day of last menstruation April 18th, 2004
- estimation delivery: January 27th, 2005
D. Marital Status
- first marriage at 23th years old, second at 35th and
husband age was 40th
Case
E. Past Obstetrical History
 1st pregnancy: in 1995, premature, spontaneously with midwife, infant
birth weight was 2200 gram, healthy
 2nd: in 1996, aterm, spontaneously with “traditional birth
attendant”,infant birth weight was 4000 gram, died in one week
 3rd: in 1998, aterm, spontaneously with “traditional birth attendant”,
infant birth weight was 3000 gram, died in one week
 4th : September 2002, SC, Hospital, aterm, infant birth weight was 3300
gram, healthy
 5th : Present pregnancy
 Case
F. Present Obstetrical History
 Early pregnancy: nausea (+), vomiting (+)
 Later Pregnancy: (-)

G. Family Planning History (-)

H. History Sistemic illness

 Hypertensi (+)

I. History of Past Surgery

 In Sept, 2002: SC

J. History Family illness (-)

K. Psychosocial & Cultural History (-)
Case
II. PHYSICAL EXAMINATION
A. Review of System
- General impression: moderat illness
- Degree of consciousness: compos mentis
- Vital sign: blood pressure 120/90
pulse 99x /m
respiration rate 20x /m
temperature 370 C
- Eyes: conjuctiva anemic (-/-)
- Cor: tachycardia (-), murmur & gallop (-)
- Pulmo: symmetrical expansion, no fermates,
no wheezing
- Extremity: warm acral, edema (-/-),
cyanosis (-/-)
Case
B. Obstetrical Status
Abdomen
Ins: longitudinally enlarged and distended, linear
nigra & stretch mark (+), transversal scar supra simfisis (+)
Pal: L 1: Fundal height 31 cm, the sensation of a large, nodular body,
not easy to move in palpation
L 2: Left : palpated numerous nodulation and small
parts
Right : hard, resistant structure, board like were
palpated
L 3: hard, round, ballotement, more freely moveable
pendular like
L 4: convergent
Case
Contraction 2x/10’/30”
Auss: fetal heartrate 152 dpm

Anogenital
Ins: vulva and urethra no sign of active
Inflammatory, edema (-), varices (-)
Io: smooth looking portio, no fluxus, no fluor
Vt: soft portio, axial, height 3 cm, dilation 1 cm,
amniotic (+), head over pelvic inlet
Case
III. Supportive Examination
Blood
Hb : 10.9
Ht : 33 vol %
L : 10500
Trombocyte : 412,000
Urine : pure yellow, 1010, epitel (+), Leuko 0-2 /lpb,
eri 4-8 /lpb, pH 8, protein (-), glukos (-), keton (-), blood (-),
bilirubin (-), urobilinogen 0.1, nitrit (-), urobilin (+)
USG : gestational age 36th weeks, hydroamnion, single life fetal with
cephalic presentation, infant birth weight 2200 gram
CTG : reactive fetal
Diagnosis
Maternal : gravidity 5, parity 4, pregnancy age 36
weeks, laten phase, hydroamniaon PSC 1x,
chronic hypertension

Fetal : one live, intrauterine fetal with cephalic presentation

Prognosis
Maternal : dubia
Fetal : dubia
Management
 Observe vital sign, fetal heart rate /30’, hiss
 Observe rupture uterine imminen sign
 Evaluate after 8 hour
 Vaginal labor planning
 Patient Condition
January 3rd, 2005: 03.00 pm
S : abdominal discomfort (+)
progressively, pain in lower
abdominal, fetal movement
(+)
O : general impression: looks
painful
degree of consciousness:
compos mentis
fetal sign: blood pressure
130/90, pulse 98x/m
RR 20x/m,
temperature 370 C
local status: abdomen
pressure pain (+), supra
simfisis
January 3rd, 2005: 04.00 pm
S : abdominal discomfort (+)
progressively, pain in lower
abdominal, fetal movement
(+)
O : general impression: looks
painful
degree of consciousness:
compos mentis
fetal sign: blood pressure
170/110, pulse 112x/m
RR 22x/m,
temperature 370 C
local status: abdomen
pressure pain (+), supra
simfisis
obstetrical status: hiss 2x/10’/30”
fetal heart rate 162 dpm
Vt: soft portio axial high 3 cm,
dilatation 1 cm, amniotic (+),
high over pelvic inlet
A : Maternal : gravidity 5, parity 4,
pregnancy age 36 weeks, laten
phase, hydroamniaon PSC 1x,
chronic hypertension, prolonged
delivery
Fetal : one live, intrauterine
fetal with cephalic presentation
P : O2 6 L/m, right position
CTG
Observation hiss, heart fetal
rate, vital sign /30 m
Observe rupture uterine sign
Check after 2 hour
obstetrical status: hiss 2x/10’/30”
fetal heart rate 178 dpm
Vt: soft portio axial high 3 cm,
dilatation 1 cm, amniotic (+),
high over pelvic inlet
A : Maternal : gravidity 5, parity 4,
pregnancy age 36 weeks, laten
phase, hydroamniaon PSC 1x,
chronic hypertension, prolonged
delivery, RUI
Fetal : one live, intrauterine
fetal with cephalic presentation,
fetal takikardi
P : SC cito
informed consent
Bricasma 0.25 mg s.c
Profenid supp.
 Post Operation Instruction
 Obs. Vital sign, contraction, bleeding/4 hours
 Early realimentation
 Mobilitation 24 hours
 Check blood post op. if Hb < 8 transfusion
 Kedacilin 3 x 1 gram iv
 Profenid 3 x 1 supp
Case Analysis
Diagnosis : gravidity 5, parity 4, pregnancy age 36
weeks, laten phase, hydroamniaon PSC 1x,
chronic hypertension,Prolonged delavery

 Predisposition factor
PSC
Multiparitas
Hidramnion
 Anamnesis
Abdominal pain (+)
PSC 1 X
 Physical examination
abdominal pain (+)
N : 120 X/ mnt (tachycardia)
DJJ : 172 dpm (fetal tachycardia)
FC  hematuria
Supporting examination
USG  hydramnion
Management
SC  I : PSC 1 X, RUI
Bricasma 0,25 mg s.c  tocolitic
profenid supp  analgetics
Conclusion
 Factor of rupture uterine  maternal factors and fetal
factors
 In this patien maternal factors are more dominan than
fetal factors
 Early diagnosis that support by immediate treatment
and complete facilities  determine prognosis of
rupture uterine
 Rupture uterine signs have to be detect in patients that
have predisposition factor of rupture uterine
 Women with SC history  prevent pregnancy for 2
years
 SC  depend on indication of last SC and delivery
process