Neglected transverse lie with uterine rupture

Extrinsic factors influencing fetal deformations and intrauterine growth restriction

The causes of intrauterine growth restriction (IUGR) are multifactorial with both intrinsic and extrinsic influences. While many studies focus on the intrinsic pathological causes, the possible long-term consequences resulting from extrinsic intrauterine physiological constraints merit additional consideration and further investigation. Infants with IUGR can exhibit early symmetric or late asymmetric growth abnormality patterns depending on the fetal stage of development, of which the latter is most common occurring in 70–80% of growth-restricted infants. Deformation is the consequence of extrinsic biomechanical factors interfering with normal growth, functioning, or positioning of the fetus in utero, typically arising during late gestation. Biomechanical forces play a critical role in the normal morphogenesis of most tissues. The magnitude and direction of force impact the form of the developing fetus, with a specific tissue response depending on its pliability and stage of development. Major uterine constraining factors include primigravida, small maternal size, uterine malformation, uterine fibromata, early pelvic engagement of the fetal head, aberrant fetal position, oligohydramnios, and multifetal gestation. Corrective mechanical forces similar to those that gave rise to the deformation to reshape the deformed structures are often used and should take advantage of the rapid postnatal growth to correct form.

Intrapartal posterior cervicoisthmic uterine rupture

A case is presented of complete intrapartal rupture of an intact, nonscarred uterus in the cervicoisthmic region in a quadripara without a history of cesarean section or other uterine operation, with dorsoposterior high longitudinal fetal head position.

Obstetric uterine rupture in north Jordan

OBJECTIVE

The purpose of our study was to determine the aetiological factors of uterine rupture during labour, and propose preventive measures.

METHODS

This retrospective study was performed between February 1989 and July 1994, to analyze the cases of rupture uterus in relation to causes, age, parity, maternal and fetal mortality and morbidity.

RESULTS

There were 37 cases of uterine rupture at our institutions. Obstructed labour by malpresentation and disproportion was the main cause. The presence of previous caesarean section scar, dysfunctional labour, injudicious use of uterine stimulant, were the other causes. There was no maternal death and the fetal loss was 17 (46%).

CONCLUSIONS

The high incidence of uterine rupture is attributed to lack of prenatal care, labour in high risk patients outside the hospital because of declining economy, and more patients with 2 or more previously scarred uterus with many of them labouring more than 14 hours. Maternal and neonatal complications have remained very high in the developing countries.