COLPORRHEXISCOLPORRHEXISASOGAAMETERAN

GROUP 5

-2013-

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

Abdominal Operation is treatment of choice

Immediate shock treatment and blood loss is imperative

Repair of vaginal laceration with / without hysterectomy in order to facilitate satisfactory exposure and repair of vaginal tear