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.
The lecture Uterine Rupture (Nursing) by Jacquelyn McMillian-Bohler is from the course Complications in Labor (Nursing).
What are the risk factors for uterine rupture? Select all that apply.
Which assessments and nursing implications are done for a uterine rupture? Select all that apply.
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