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Re: Uterine Rupture and Hysterectomy

From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Wed, 26 Jul 2000 17:44:48 -0500 (CDT)

At Wed, 26 Jul 2000, Ed wrote: >
>Hello. My wife recently gave birth to our only child. Her due date was
>July 15th and he was born on the 17th. She was told 3 weeks earlier
>that the baby was going to be 9 lbs 8 ounces. So the doctors did 2
>sonograms one saying 6 lbs 11 ounces and the other 7 lbs 5 ounces. She
>we felt there was no reason for alarm so we continued as usual. When
>she went into labor and dialated to 10 cm she started pushing. She
>pushed for 2 hours and the baby didn't move. The doctor then went for a
>c/s. After the c/s in recovery my wife started passing enormous amounts
>of blood vaginally. The doctor had left and counldn't be found for an
>hour and a half while my wife was bleeding almost to death. After he
>returned they decided that a hysterectomy was inevidable much to all of
>our chagrin. The doctor told us that because of the size of the baby it
>caused her uterus to elasticate and unable to stop her from bleeding. I
>feel that pushing for too long during labor may have caused her uterus
>to rupture. Is this a possible senario? Or the possiblity that she bled
>for so long after her c/s (1.5 hrs)caused her uterus to hemmorage beyond
>repair. I am very unsure and would like some education on the subject.
>Thank you
>
> Respectfully,
> Edward Egan

Ed, First, are you sure the uterus was "ruptured". It sounds by your description that your wife pushed for 2 hours and was taken for a cesarean because of failure to progress. It the uterus were ruptured, that is usually a surgical emergency and presents differently. You don't mention the actual birth weight, only the antenatal estimates. The fact that your wife went to completely dilated, then pushed for two yours is very normal. Most standards recommend that as long as the baby and mom are doing well, you allow AT LEAST 2 hours of pushing. You can actually allow more if there is any progress, but you should assess at two hours and if no change, it is reasonable to proceed with a cesarean. It is true that large babies can result in the uterus not clamping down the way it should following delivery. This is called uterine atony. In some cases, when the bleeding is severe enough, hysterectomy is required. As a matter of fact, I personally did one last Thursday... Lynn 

--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana


**Note:  Opinions expressed here are for educational purposes only and, as such, do not constitute a physician-patient relationship.  This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.


**Private e-mails cannot be entertained due to time constraints, consequently no private e-mails will receive a response.


**Thank you for your understanding ;-)



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