Uterine Rupture (Nursing)

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.