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Rupture of the cesarean section scar in subsequent pregnancy or labor
220 should woman
THE
-4XIERICAX
.JOURNBL
OF
OBSTETRICS
GlWECOLQUP
be performell at the advent of labor. If no pelvic obstruction should be given a trial of labor under careful supervision.
Conservative cesarean sections, practiced very slightly against the obstetrical future ture in subsequent pregnnncics dots exist. rendering it smaller.
Holland, Eardley : nancy OP Labor. pire,
AXD
1922,
xxviii,
Rupture Journal 48s.
Obstetrics
the
under proper conditions, militate of women. Though the risk of rupifr is small and improved technic is R.. T. IAVAKE.
of the Cesarean Section nf
exists,
xnd
Scar in Subsequent
Gpnnccology
of the
-British
PregEm-
Of 97 cases reported in detail sufficient for study two-thirds have appeared in the last ten years. Of 85 cases noted, rupture followed longitudinal fundal incision in 55, transverse incision in 28 and incision of the lower uterine segment once. As yet final judgment is rescrred on the security of the lower uterine scars. From the etiologic standpoint such accidental factors as twins, hydramnios, version, the use of hydrostatic bags and pituitrin were recorded only 17 times. Wpture of a thin scar may ocellr from the intrauterine pressure of normal labor. In 78 out of 57 cases of rupture the accident occurred at or within one month of term. Tn several cases the rupture had apparently occurred early in pregnancy or a gap in the scar of a previous section had remained open, tha aperture being closed by adhesions only. In 32 out of 31 casts in which loration of placenta was stated the placenta was attached under the eito of rupt urc. Anatomical studies both from reoperation aud postmortem show that frcsquently the contractile muscle of the upper uterine segment pulls away from the incision leaving only a bridge of peritoneum and cnclometrium to heal. Microscopic study reveals no analogy bet\veen the erosion and rupture of a tube in ectopic pregnancy and the rupture of a uterine scar. Sepsis seems 11) be the most common cause of imperfectly healed scars. Reoperation shows that the absence of temperature does not exclude sepsis in a wound. Silkworm gut Retraction should is the ideal suture material for potentially infected cases. l,e complete before suture of the uterine wound. Transverse fundal incisions are mechanically bad. It is often forgotten that when women delivered tion are alloTed to labor in subsequent pregnancy primiparous la.bor. Although shock, pain, collapse, tion of labor pains and distinct palpation of fetal of rupture, often the gradual occurrence of the markedly. Due to hemorrhage the presence of the rupture makes the accident more serious.
previously they may signs of parts are accident plnccnta
by cesaretLn sechave virtually :I. hemorrhage, cessathe classical sign.5 alters the picture under the site of
In (ii out of 89 cases, rupture involved practically the entire sear. Of TU casts where treatment was possible 56 received hysterectomy, 26 wound suture, Sixty-six out of 94 mothers recoverccl. 2 vaginal hysterectomy and 2 drainage. Twenty-one out of 90 babies mentioned lived. Out of 1103 cesarean sections done previous to 1918, 487 have subsequently become pregnant. Of these 47 ended in abortion (spont,aneous or induced), 78 delivered normally and 352 were Rupture of the uterine sear occurred in 4% of delivered by cesarear: section. the 448 women who carried to term. Rupture in subsequent pregnancy oc’curred 15 times in 301 cases of eesarean section where catgut was used in the uterine wound, twice in 93 cases where the suture material was silk and in no cases where silkworm-gut was used. For theoretical reasons silkworm-gut is the H. W. SHUTTFR. most suitable uterine suture material.
THE
-4XIERICAX
.JOURNBL
OF
OBSTETRICS
GlWECOLQUP
be performell at the advent of labor. If no pelvic obstruction should be given a trial of labor under careful supervision.
Conservative cesarean sections, practiced very slightly against the obstetrical future ture in subsequent pregnnncics dots exist. rendering it smaller.
Holland, Eardley : nancy OP Labor. pire,
AXD
1922,
xxviii,
Rupture Journal 48s.
Obstetrics
the
under proper conditions, militate of women. Though the risk of rupifr is small and improved technic is R.. T. IAVAKE.
of the Cesarean Section nf
exists,
xnd
Scar in Subsequent
Gpnnccology
of the
-British
PregEm-
Of 97 cases reported in detail sufficient for study two-thirds have appeared in the last ten years. Of 85 cases noted, rupture followed longitudinal fundal incision in 55, transverse incision in 28 and incision of the lower uterine segment once. As yet final judgment is rescrred on the security of the lower uterine scars. From the etiologic standpoint such accidental factors as twins, hydramnios, version, the use of hydrostatic bags and pituitrin were recorded only 17 times. Wpture of a thin scar may ocellr from the intrauterine pressure of normal labor. In 78 out of 57 cases of rupture the accident occurred at or within one month of term. Tn several cases the rupture had apparently occurred early in pregnancy or a gap in the scar of a previous section had remained open, tha aperture being closed by adhesions only. In 32 out of 31 casts in which loration of placenta was stated the placenta was attached under the eito of rupt urc. Anatomical studies both from reoperation aud postmortem show that frcsquently the contractile muscle of the upper uterine segment pulls away from the incision leaving only a bridge of peritoneum and cnclometrium to heal. Microscopic study reveals no analogy bet\veen the erosion and rupture of a tube in ectopic pregnancy and the rupture of a uterine scar. Sepsis seems 11) be the most common cause of imperfectly healed scars. Reoperation shows that the absence of temperature does not exclude sepsis in a wound. Silkworm gut Retraction should is the ideal suture material for potentially infected cases. l,e complete before suture of the uterine wound. Transverse fundal incisions are mechanically bad. It is often forgotten that when women delivered tion are alloTed to labor in subsequent pregnancy primiparous la.bor. Although shock, pain, collapse, tion of labor pains and distinct palpation of fetal of rupture, often the gradual occurrence of the markedly. Due to hemorrhage the presence of the rupture makes the accident more serious.
previously they may signs of parts are accident plnccnta
by cesaretLn sechave virtually :I. hemorrhage, cessathe classical sign.5 alters the picture under the site of
In (ii out of 89 cases, rupture involved practically the entire sear. Of TU casts where treatment was possible 56 received hysterectomy, 26 wound suture, Sixty-six out of 94 mothers recoverccl. 2 vaginal hysterectomy and 2 drainage. Twenty-one out of 90 babies mentioned lived. Out of 1103 cesarean sections done previous to 1918, 487 have subsequently become pregnant. Of these 47 ended in abortion (spont,aneous or induced), 78 delivered normally and 352 were Rupture of the uterine sear occurred in 4% of delivered by cesarear: section. the 448 women who carried to term. Rupture in subsequent pregnancy oc’curred 15 times in 301 cases of eesarean section where catgut was used in the uterine wound, twice in 93 cases where the suture material was silk and in no cases where silkworm-gut was used. For theoretical reasons silkworm-gut is the H. W. SHUTTFR. most suitable uterine suture material.