Uterine Rupture (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    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.

    About the Lecture

    The lecture Uterine Rupture (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Complications in Labor (Nursing).

    Included Quiz Questions

    1. History of vaginal birth after cesarean (VBAC)
    2. Polyhydramnios
    3. Fetal macrosomia
    4. History of vaginal birth
    5. History of cholecystectomy
    1. Assess for decreased or variable decelerations
    2. Prepare for blood transfusion administration
    3. Apply oxygen
    4. Alert OR team only if sharp pain is present
    5. Prepare for immediate vaginal birth

    Author of lecture Uterine Rupture (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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