00:01
Let's talk about
the next complication,
a uterine rupture.
00:05
So a uterine rupture
by definition
is separation of the layers
of the uterus.
00:10
This could happen either
spontaneously
for no reason at all,
or maybe a previous uterine scar
from a previous birth
or some type of surgery
could also open.
00:22
Risk factors:
VBAC or TOLAC.
00:25
Those are really fancy names,
but what they mean
VBAC stands for
Vaginal Birth After Cesarean,
previous cesarean birth,
or before they deliver,
they're called a TOLAC,
Trial of Labor After Cesarean.
00:41
We could also have a situation
where we have
over distension of the uterus.
00:45
So if the uterus is really big,
much bigger than it's supposed to,
it is predisposed to opening up
wherever there's a previous scar
or opening up spontaneously.
00:55
So thinking about
anything that could cause
over distension of the uterus,
like polyhydramnios,
or having lots of babies
in the uterus,
or having a really big baby
in the uterus.
01:08
So any of those things
that cause over distension.
01:12
Grand multiparity.
01:13
So if you've had
lots of babies previously,
then the uterine muscle
is a lot weaker
than it might be ordinarily.
01:21
And so the potential
for the scar to open up
maybe that
it's been there previously,
is much higher.
01:27
And again,
any previous uterine surgery.
01:31
So maybe it had nothing
to do with a baby,
no cesarean birth,
but there was
some other type of surgery.
01:37
Maybe to remove a fibroid
or something else,
that same incision
could open up
under the strain of the contractions
of the uterus.
01:46
So what will we notice
if we are experiencing
or if the client is experiencing
a uterine rupture?
One of the classic signs
is the client may just describe
this really sharp tearing pain.
01:57
And I cannot stress enough
when the client tells you something,
you need to listen.
02:02
Oftentimes, emergencies could either
be avoided or minimized,
if we actually listen
to what the client tells us.
02:09
They may not know what it is.
They just know something's wrong.
02:12
It's our job to figure out
what that something is.
02:15
Now, as much as I heart
listening to the client,
they may not even notice
that their uterus has opened.
02:21
So it may be completely painless.
02:23
And we have to then depend on
other things to clue us in.
02:26
There may be an abrupt change
in the fetal heart tones.
02:30
We may begin to see decelerations
or even bradycardia,
where the heart rate
goes down and stays down.
02:36
We might find that the cord
actually slips through that opening.
02:40
And then we have a situation again,
where we see those deep variables
because of cord compression.
02:46
In a worst case scenario,
we may actually have a situation
where the fetus begins to come out
of that opening in the uterus.
02:52
And so you as the provider
may actually be able to feel
feet, fingers,
or something else like that actually
coming through that uterine scar.
03:02
So what do we do?
We're going to prepare
for an immediate cesarean birth.
03:06
And that needs to happen
really quickly.
03:08
And in most cases,
if the uterine rupture
does not happen in the hospital,
the mortality rate
is really high.
03:14
And we almost always are
going to lose the fetus.
03:17
So we really have to move
very quickly to the OR,
if we're in-house.
03:21
We want to make sure that
the IV works and that it is patent.
03:25
And that we have fluid going
because we're going to have
to get this patient to sleep
as fast as possible.
03:30
We want to make sure
that we have oxygen.
03:32
So make sure you've got
the non-rebreather mask,
that's the mask with the bag
at the bottom
because that's going to give us
the highest concentration of oxygen.
03:41
Now, because we have an issue
where the uterus has opened up,
there's a potential for bleeding.
03:47
So we need to be ready
for a possible blood transfusion.