142325 633685436151105144

UTERINE RUPTURE

palenCALIAO

emjaySINAHON

nininSOJOR

• spontaneous or traumatic rupture of the uterus ie., the

actual separation of the uterine myometrium/ previous

uterine scar, with rupture of membranes and extrusion of

the fetus or fetal parts into the peritoneal cavity.

• Dehiscence - partial separation of the old uterine scar;

- the fetus usually stays inside the uterus and

the bleeding is minimal when dehiscence occurs.

Ruptured uterus

RISK FACTORS:•Women who have had previous surgery on the uterus (upper muscular portion)

•Having more than five full-term pregnancies

•Having an overdistended uterus (as with twins or other multiples)

•Abnormal positions of the baby such as transverse lie.

•Use of Pitocin (oxytocin) and other labor-induced medications (prostaglandin)

•Rupture of the scar from a previous CS delivery/hysterectomy.

•Uterine/abdominal trauma

•Uterine congenital anomaly

•Obstructed labor; maneuvers within the uterus

•Interdelivery interval (time between deliveries)

Pathologic retraction ring occurs, strong uterine contractions w/o cervical dilatation

“tearing sensation”

Complete rupture Incomplete rupture

Rupturing of endometrium, myometrium and perimetrium

Rupturing of endometrium and myometrium

PATHOPHYSIOLOGY

Uterine contraction stopsLocalized tenderness and

persisting aching pain over the area of the uterine segment

Bleeding into the peritoneal cavity

Decreased venous return

Decreased BP

Heart attempts to circulate remaining blood volume

Vasoconstriction of peripheral vessels, increased heart rate

Swelling of the abdomen:•Retracted uterus•Extrauterine fetus

Hemorrhage from torn uterine arteries

Bleeding to the vagina

Decreased blood volume Decreased cardiac output

Increases gas exchange to oxygenate better the decreased

blood volume

Cold, clammy skin

Increased respiratory rate

Continued blood loss will continue to fall BP

Uterine perfusion is decreased

Fetal distress

Decreased brain perfusion

Decreased kidney perfusion

Decreased LOC (lethargy, coma) Decreased urine output

Renal failure

Death of Mother and fetus

ASSESSMENT:•evaluate maternal vital signs•note an increase in rate and depth of respirations, an increase in pulse , or a drop in BP indicating status change•assess fetal status by continuous monitoring•speak with family, and evaluate their understanding of the situation•observe for signs and symptoms of impending rupture

-lack of cervical dilatation-tetanic uterine contractions- restlessness- anxiety- severe abdominal pain- fetal bradycardia- late or variable decelerations of the FHR)

SIGNS AND SYMPTOMS

Developing Rupture

•Abdominal pain and tenderness

•Uterine contractions will usually continue but will diminish in intensity and tone.

•Bleeding into the abdominal cavity and sometimes into the vagina.

•Vomiting

•Syncope; tachycardia; pallor

•Significant change in FHR characteristics – usually bradycardia (most significant

sign)

Clinical Manifestations:

Violent Traumatic Rupture

•Sudden sharp abdominal pain during or between contractions.

•Abdominal tenderness

•Uterine contractions may be absent, or may continue but be diminished in intensity

and cord

•bleeding vaginally, abdominally, or both

•Fetus easily palpated in the abdominal with shoulder pain

•Tenses, acute abdominal with shoulder pain

•Signs of shock

•Chest pain from diaphragmatic irritation due to bleeding into the abdomen.

NURSING DIAGNOSIS AND INTERVENTIONS

Start or maintain an IV fluid as prescribed. Use

a large gauge catheter when starting the IV for

blood and large quantities of fluid replacemnt.

Maintain CVP and arterial lines, as indicated for

hemodynamic monitoring.

Maintain bed rest to decrease metabolic

demands.

Insert Foley catheter, and moniter urine output

hourly or as indicated.

Obtain and administer blood products as

indicated.

Deficient Fluid Volume

FearGive brief explanation to the woman and her support

person before beginning a procedure.

Answer questions that the family or woman may have.

Maintain a quiet and calm atmosphere to enhance

relaxation.

Remain with the woman until anesthesia has been

administered; offer support as needed.

Keep the family members aware of the situation while the

woman is in surgery and allow time for them to express

feelings.

Decreased cardiac output•Administer supplemental oxygen, blood/fluid replacement, antibiotics, diuretics, inotropic drugs, antidysrhythmics, steroids, vassopressors, and/or dilators as ordered.•Position HOB flat or keep trunk horizontal while raising legs 20 to 30 degrees in shock situation•Activities such as isometric exercises, rectal stimulation, vomiting, spasmodic coughing which may stimulate Valsalva response should be avoided; administer stool softener as indicated.

Administer O2 using a face mask at 8-12 L/min or

as ordered to provide high oxygen concentration.

Apply pulse oximeter, and monitor oxygen

saturation as indicated.

Monitor ABG levels and serum electrolytes as

indicated to assess respiratory status, observing for

hyperventilation and electrolyte imbalance.

Continually monitor maternal and fetal vital signs

to assess pattern because progressive changes may

indicate profound shock.

Ineffective Tissue Perfusion

Risk for Infection

• Observe for localized signs of infection.

•Cleanse incision or insertion sites daily

and PRN with povidone iodine or other

appropriate solutions.

•Change dressings as needed or indicated.

•Encourage early ambulation, deep

breathing, coughing and position changes.

•Maintain adequate hydration and

provide.

•Provide perineal care.

MEDICAL MANAGEMENT•Immediate stabilization of maternal

hemodynamics and immediate

caesarean delivery

•Oxytocin is given to contract the uterus

and the replacement .

•After surgery, additional blood, and

fluid replacement is continued along

with antibiotic theory.

SURGICAL MANAGEMENT•Caesarean Section

•Laparotomy

•Hysterectomy

NURSING MANAGEMENT•Continually evaluate maternal vital signs;

especially note an increase in rate and depth of respirations, an increase in pulse , or a drop in BP indicating status change.•Assess fetal status by continuous monitoring.•Speak with family, and evaluate their understanding of the situation. •Anticipate the need for an immediate caesarean birth to prevent rupture when symptoms are present.•Provide information to the support person and inform him or her about fetal outcome, the extent of the surgery and the woman’s safety.•Let the pt express her emotion without feeing threatened.

Thank you for listening!!!