COLPORRHEXIS
COLPORRHEXIS
COLPORRHEXIS
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.
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
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
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