COLPORRHEXIS

ASOGAAMETERAN 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 pains Sudden 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