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9. Genito-urinary diseases
Abruptio placenta
H aem atom a th at form s betw een th e placenta and th e uterine w all as a result of
separation of th e placenta, prior to foetal expulsion.
Clinical features
– Dark slig h t bleed ing , som etim es absent, or sh ock not alw ays consistent w ith th e
external blood loss as bleed ing is internal.
– S ud d en, sev ere, continuous abd om inal pain.
– T ig h tly contracted uterus; often, foetal h eart sound s absent (foetal d eath ).
– O ften occurs in a context of pre-eclam psia.
Management
Refer to surg ical facility.
Uterine rupture
T ear in th e uterine wall, in m ost cases d uring labour, often related to inappropriate use
of oxytocin.
Clinical features
– Im pend ing rupture: prolong ed labour, ag itation, alteration of th e g eneral state, poor
uterine relaxation, continuous abd om inal pain, m ore sev ere th an th e contractions.
– Rupture: d isappearance of uterine contractions, sh ock; som etim es, palpation of th e
d ead foetus expelled into th e m aternal abd om en.
Management
Refer to surg ical facility for em erg ency laparotom y.
Premature labour
Clinical features 9
Cerv ical ch ang es (effacem ent and d ilatation) and reg ular uterine contractions before
37 w eeks LM P . M etrorrh ag ia are not always present in prem ature labour. If present,
blood loss is usually m inim al.
Management
– S trict bed rest.
– Allow labour to prog ress in th e following cases: g estation is m ore th an 37 weeks; th e
cerv ix is m ore th an 3-4 cm d ilated ; th ere is sig nificant bleed ing ; th e foetus is
d istressed or d ead ; th ere is am nionitis or pre-eclam psia.
– O th erwise, tocolysis:
As first-line treatm ent, nifedipine P O (sh ort-acting capsule): 10 m g by oral route, to be
repeated ev ery 15 m inutes if uterine contractions persist (m axim um 4 d oses or
40 m g ), th en 20 m g ev ery 6 h ours for 48 h ours.
249
Abruptio placenta
H aem atom a th at form s betw een th e placenta and th e uterine w all as a result of
separation of th e placenta, prior to foetal expulsion.
Clinical features
– Dark slig h t bleed ing , som etim es absent, or sh ock not alw ays consistent w ith th e
external blood loss as bleed ing is internal.
– S ud d en, sev ere, continuous abd om inal pain.
– T ig h tly contracted uterus; often, foetal h eart sound s absent (foetal d eath ).
– O ften occurs in a context of pre-eclam psia.
Management
Refer to surg ical facility.
Uterine rupture
T ear in th e uterine wall, in m ost cases d uring labour, often related to inappropriate use
of oxytocin.
Clinical features
– Im pend ing rupture: prolong ed labour, ag itation, alteration of th e g eneral state, poor
uterine relaxation, continuous abd om inal pain, m ore sev ere th an th e contractions.
– Rupture: d isappearance of uterine contractions, sh ock; som etim es, palpation of th e
d ead foetus expelled into th e m aternal abd om en.
Management
Refer to surg ical facility for em erg ency laparotom y.
Premature labour
Clinical features 9
Cerv ical ch ang es (effacem ent and d ilatation) and reg ular uterine contractions before
37 w eeks LM P . M etrorrh ag ia are not always present in prem ature labour. If present,
blood loss is usually m inim al.
Management
– S trict bed rest.
– Allow labour to prog ress in th e following cases: g estation is m ore th an 37 weeks; th e
cerv ix is m ore th an 3-4 cm d ilated ; th ere is sig nificant bleed ing ; th e foetus is
d istressed or d ead ; th ere is am nionitis or pre-eclam psia.
– O th erwise, tocolysis:
As first-line treatm ent, nifedipine P O (sh ort-acting capsule): 10 m g by oral route, to be
repeated ev ery 15 m inutes if uterine contractions persist (m axim um 4 d oses or
40 m g ), th en 20 m g ev ery 6 h ours for 48 h ours.
249
