Malformations can cause dystocia
INTRODUCTION
For
pregnancy and labour to be achieved with minimal difficulty, a woman must have
normal reproductive anatomy. When
structural abnormality of the pelvic organs exists, problems arise which can
place an extra burden on mother and fetus.
Dystocia may result from malformations and displacement.
DEFINITION
Uterine
malformations is defined as the malformations and displacement of the body of
uterus caused by the persistence to a greater or lesser extend of the septum
between the mullarian duct.
TYPES
OF UTERINE MALFORMATIONS
They are:-
1.
Arcuate Uterus
2.
Uterus didelphys
3.
Uterus bicornis
4.
Uterus unicornis
5.
DES – Related abnormality
1) Arcuate Uterus
The
corneal part of the uterus remains separated.
The uterine fundus looks concave with heart shaped cavity outline.
2) Uterus didelphys
There
is a complete look of fusion of the mullarian ducts with a double uterus,
double cervix and a double vagina.
3) Uterus bicornis
This
is of varying degree of fusion of the muscle walls of the two ducts.
1. Uterus bicornis bicollis
There are 2
uterine cavities with double cervix with or without vaginal septum.
2. Uterine bicornis unicollis
There are 2
uterine cavities with one cervix. The
horns may be equal or one horn may be rudimentary and have no communication
with development horn.
3. Septate Uterus
The two
mullarian ducts fused together but there is persistence of septum in between
the two either partially (sub-septable) or completely.
6. Uterus unicornis
Failure of
development of one mullarian ducts
7. DES – Related abnormality
If it is due
to DES exposure during intrauterine life varieties of malformations are
included.
Eg: Hypoplasia
Uterus ‘T’ shaped uterus and cervical hypoplasia.
CLINICAL
FEATURES
They
are classified into gynaecological and obstetrical.
1.
Gynaecological
1.
Infertility and dyspareunia.
2.
Dysmenorrhoea.
3.
Menorrhagia
2. Obstetrical
1.
Mid trimester abortion
2.
Cornual pregnancy with
inevitable rupture around 16th week.
3.
Increased incidence of
malpresentation
4.
Preterm labour
5.
Prolonged labour
6.
Obstructed labour
7.
Retained placenta and PPH.
Effect of Uterine Malformations on Pregnancy
If
their insufficient hypertrophy the possible difficulties are
·
Abortion
·
Pre-mature labour
·
Abnormal lie of the fetus
·
In labour there will be poor
uterine function may be experienced.
·
Occasionally problems arise
when a fetus is accommodated in one horn
of this double uterus and the empty of the horn has filled the pelvic cavity.
Diagnostic
Evaluation
1.
Internal Examination reveals
separate vagina and two cervix.
2.
Hysterography
3.
Hysteroscopy
4.
Ultrasonography
5.
MRI
6.
Laproscopy
MANAGEMENT
a) Surgical Management
1.
Strassman Utriculoplasty
Operation
2.
Jonis Wedge Metroplasty
3.
Tomkins operation
4.
Hysteroscopic Ressection
NUSRING MANAGEMENT
·
The nurse should give
psychological support to the patient.
·
Send the blood and urine for routine
examination.
·
Check the vital signs every 4th
hrly.
·
Assess for any systemic
diseases such as DM, HTN, TB etc.
·
Obtain consent for operation.
·
Mother should be kept nil by
mouth.
·
Pre-operative medication should
be given such as Inj-TT.
·
Prophylactic antibiotics such
as cephalosporins to reduce the risk of infection.
·
Preparation of the part should
be done with antiseptic solutions.
POST-OPERATIVE CARE
·
Provide comfortable position i.e., supine position.
·
Give foot end elevation.
·
Monitor the vital signs.
·
Observe the patient for any
signs of infection.
·
Assess the incision site for
bleeding.
·
Maintain aseptic techniques in
all procedure.
·
Administer antibiotics to
prevent the infection.
·
Administer analgesics to
relieve pain.
·
Change the soiled dressings at
least twice a day.
·
Provide calm and quit
environment.
CONCLUSION
Malformations
can cause dystocia. Malformations may be
congenital or may be acquired. This can
be managed by surgical intervention.
BIBLIOGRAPHY
1.
Howkin and Bourne Shaw’s “Text
Book of Gynaecology”, V.G.Pudubidri Shirish N Buftaly 13th Edition,
Page No.91-94.
2.
A.L.Mudaliar’s “Clinical
Obstetrics” Published by Orient Longman Ltd., 9th Edition, Page
No.102.
3.
D.C.Dutta “Text Book of
Obstetrics Including Perinatology and Contraception”, 16th Edition,
Pg.No.162-164.
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