Separation of the uterus from the vaults of the vagina (colpoporrhexis)

Separation of the uterus from the vaults of the vagina is a kind of uterine rupture. He first described by domestic author F. G. Gutenberg (1875).
Separation of the uterus occurs most commonly in the lower segment of the uterus, either on the front or on the rear panel. Significantly less likely to have another form of separation of the uterus from the vaults of the vagina is not within the lower segment, and a little below it, on the level of the vault of the vagina.
Tear the roof of the vagina threatens a woman's life because of the possibility of fatal bleeding or wound infections.
Usually the gap codes occurs at the thinnest point of the vagina, near the cervix. The gap vagina creates a gaping wound through which it is possible to fall out of the loop guts, gland, the mesentery and other organs. Fortunately, this complication occurs very rarely.
The default codes are spontaneous and violent. When a violent rupture is always rough, excessive use of physical force during obstetric operations, whether temporaria, metrals, obstetric turn, manual separation of the placenta, forceps delivery. With spontaneous rupture the main role is played by pathological changes in tissues of the vault of the vagina due to injuries sustained in the previous childbirth, inflammatory and degenerative processes that are related mostly to childbirth in some cases arising independently of the latter.
Changes in the tissues of the vaults are reduced to hyaline rebirths, sclerosis, reduces their muscle and elastic fibers through the development of connective tissue, edema, extravasation and development of venous vessels.
Microscopic picture of tissue taken from a rupture of the code, Porosino, is as follows: "Immediately under the peritoneum noted the tremendous development of blood vessels: the artery walls were very thick, and Vienna - thin, the latter are very stretched, which gives the cavernous tissue. Muscle tissue is almost not visible; instead dominated by bundles of fibers, rich old fusiform cells; seats bunch of fibres are separated by hemorrhages and propisyvayutsya huge number of round cells; elastic tissue in these places is not visible traces of it are found only in the walls of arteries, and fiber seem short, knotted with irregular thickening at the ends". The consequence of this are:
1) thinning of codes due to the tension;
2) scar tissue in places abrasions, fractures and lacerations;
3) colpitis, Paraclete, parameters etc.
Under these conditions, prolonged labor or excessive violence used in cases of operational delivery, causes restretching modified tissue and its gap. Considering these changes, we must not forget that the predisposing causes of the gaps are narrow pelvis, tumors of the uterus, cervix and swelling in the pelvis.
The separation mechanism of the vault of the vagina to the uterus can be presented as follows. Quite open neck (Zev) went for head up, it can no longer be infringed between the head and the wall of the pelvis. The uterus is also continuously being reduced, pulls vaults, which are connected with pelvic bottom, and is not free to follow the movement of the lower uterine segment. There comes a time when the tension reaches its highest limit and fabric torn (especially when their inferiority in terms of morphology). Most often occur back arch, the walls of which are much thinner and more strengthened Sacro-uterine ligaments.
Break the vault of the vagina more often in nagaragawa, as they elastic tissue in the joint area of the neck and the vaults are gradually replaced by connective tissue.
Appearance of RAS with colpoporrhexis varies depending on producing of reasons. In the presence of prolonged pressure of a rupture edges are represented cut, crushed and dead skin on a greater or lesser extent, in cases resulting from obstetric surgery, the edges are clean and smooth. The direction of spontaneous breaking codes always cross, forced - longitudinal, and often damaged and the neck.
The recognition of "non-invasive" breaks the code of difficulty is not, "penetrating" can easily be mixed with rupture of the uterus, as the signs are very similar, especially if the fetus (or part of it) was in the abdominal cavity.
Break the codes usually preceded by an unusually strong tribal activity that is quickly replaced by the full termination of labour; there is a strong contraction ring; from the genital parts follows the blood. Many authors indicate that the gap codes of patients do not catch, meanwhile, uterine rupture, they feel quite evident. The pulse of the patient quickens; vomiting because of peritoneal irritation, often hiccups.
The choice of surgical intervention is performed depending on the nature of the failure.
Only in case of small (non-penetrating) breaks the need for surgery disappears. When penetrating breaks the choice of benefits depending on the specific features of the case. Appropriate here as vaginal and brunetoochka methods. With a growing danger to life of women chrevosechenie is more appropriate.
To start chrevosechenie follows immediately upon detection of break, which is usually after birth. If the gap is detected before birth, followed quickly by adorability woman. As for the manipulation chrevosechenie, they should be conform with the degree of separation and the state of the tissue. In some cases, applicable mending the gap, in other - the complete removal of the uterus with application in individual cases drainage (infection).
Prevention should be aimed at elimination of the factors predisposing to severe sprain codes and their separation. Hence, any attempt to patch a running transverse position of the fetus (even living)should not take place, as well as should not be abused operational benefits in the apparent mismatch between the size of the head and pelvis.