Uterine Anomalies

UTERINE PROLAPSE

What is uterine prolapsed?

•Uterine prolapse is falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal

Causes:

• Multiparity

• When the muscles and connective tissues weakens

• Normal aging and lack of estrogen hormone after menopause

• Chronic constipation

• Pelvic tumor

Symptoms

• A feeling as if "sitting on a small ball"

• Difficult or painful sexual intercourse

• Low backache

• Protrusion from the vaginal opening

• Sensation of heaviness or pulling in the pelvis

• Vaginal bleeding

Three (3) degrees of uterine prolapse:

• 1st degree- the cervix is visible at the vaginal introitus, or opening without straining.

• 2nd degree- the cervix is extends beyond the vaginal opening to the perineum

• 3rd degree- the uterus protrudes outside of the vagina. This severe condition is called procidentia uteri

Woman who are at risk:

• Woman with multiparity

• Inability to maintain the perineal musculature

• Woman with chronic constipation

• Woman with lack of estrogen level after menopause

ADPIE

FOR UTERINE PROLAPSE

Assessment:

• Physiologic changes• Behavioral changes• Patient’s past experiences with health

problems• Patient’s and family’s perception of

patient’s health problem• History of multiple pregnancies, prolonged

or difficult labor• Age• Vital signs

Diagnosis:• Stress urinary incontinence related to

weak pelvic musculature• Disturbed body image related to

biophysical changes

Planning:• Patient will maintain continence• Patient will state increase of comfort• Patient will acknowledge change in body

image• Patient will demonstrate ability to practice

new coping behavior

Intervention:

• Accept patients perception of self• Make use of relaxation techniques to

promote comfort for the patient• Encourage patient to participate

actively in performing care• Provide appropriate care for patient’s

condition, monitor progress• Promote patient’s wellness through

education• Administer medications as prescribed

Intervention:

• Accept patients perception of self• Make use of relaxation techniques to

promote comfort for the patient• Encourage patient to participate

actively in performing care• Provide appropriate care for patient’s

condition, monitor progress• Promote patient’s wellness through

education• Administer medications as prescribed

UTERINE RUPTURE

The term “uterine rupture” is used from anything in a continuum of events, from a weak spot in the uterine wall noticed by the surgeon at the time of cesarean to the catastrophe of the uterus tearing open and the fetus, placenta, and a lot of blood extruding into the mother’s abdomen.

A 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 is the partial

separation of the old uterine scar; the fetus usually stays inside

the uterus and the bleeding is minimal when dehiscence occurs.

Who is at risk of uterine rupture?

• Woman who have previous surgery on the uterus• Prior classical cesareans, where the incision is

near the top of the uterus• Prior removal of fibroid tumors if the incision

extended through the full thickness of the uterine wall

• Any other surgery that went through the full depth of the muscular portion of the uterus

• Grand multiparity• Fetal malpresentation• Labor- inducing medications• Multiple gestation

What are signs of uterine rupture?

• Localized pain and abnormalities of the fetal heart rate

• There may be vaginal bleeding and the vaginal examination ,may show that the baby is not as low in the birth canal as he had been earlier.

Rupture of the uterus during pregnancy or labor is a serious emergency that can be fatal to both mother and fetus. Uterine rupture results in:

• bleeding; • rupture of the amniotic sac (bag of waters); • partial or full delivery of the fetus into the

abdominal cavity; and • loss of oxygen delivery to the fetus.

Classic symptoms of rupture include:

• pain above and beyond normal labor pain; • discontinuation of uterine contractions; • signs of fetal heart rate abnormalities; • hemorrhage; and • shock.

How to prevent uterine rupture?

• Sudden severe abdominal pain in later pregnancy should be reported to your physician,especially if you are at increased risk for rupture of the uterus.

• Women with risk factors such as prior classical cesarean, deep fibroid excisions, and other major uterine surgeries should not attempt labor, and should be scheduled for cesarean as soon as the fetus is expected to do well out in the wolrd, usually 36 and 39 weeks of gestation.

ADPIE FOR UTERINE RUPTURE

Assessment:

• Descriptive characteristic of pain, including location, quality, intensity on a scale of 1-10, temporal factors and sources of relief

• Fluid and electrolyte status, including weight, intake and output, urine specific gravity, skin turgor, and mucous membranes

• Physiologic factors such as age and pain tolerance.• Physiological variables, such as body image, personality,

previous experience with pain, anxiety, and secondary gain.• Pulse, blood pressure, respirations, and temperature• 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.

• Observe for signs and symptoms of impending rupture (ie, lack of cervical dilatation, tetanic uterine contractions, restlessness, anxiety, severe abdominal pain, fetal bradycardia, or late or variable decelerations of the FHR).

• Assess fetal status by continuous monitoring.• Speak with family, and evaluate their understanding of the

situation.

Diagnosis:

• Deficient Fluid Volume related to active fluid loss from hemorrhage

• Fear related to surgical outcome for fetus and mother

• Acute pain related to biophysical factors

• Health seeking behaviors related to lack of information about signs of delayed postpartal hemorrhage

Planning:

• Patient will identify pain characteristics• Patient will articulate factors that intensify

pain and will modify behavior accordingly• Patient will express feeling of comfort and

relief of pain• Patient’s vital signs will remain stable• Skin color evaluation will remain normal• Fluid volume will remain adequate• Fluid and blood volume will return to

normal

Intervention:

• Assess patient’s signs and symptoms of pain and administer pain medication as prescribed

• 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.

• Perform comfort measures to promote relaxation such as relaxation techniques

• Administer fluids, blood or blood products• Give 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.

Evaluation:

• Patient is able to identify characteristics of pain

• Patient is able to articulate factors that intensify pain and modifies behavior accordingly

• Patient is able to express feeling of comfort and relief of pain

• Patient’s vital signs remains stable• Skin color evaluation remains normal• Fluid volume remains adequate• Fluid and blood volume returns to normal

THANK YOU!!!