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Uterine Rupture
Uterine Rupture
Disruption of the uterine wall any time beyond the 28th weeks of pregnancy
Dissolution in the continuity of the Uterine wall any time beyond 28th weeks of
pregnancy is called rupture of the Uterus. -It is an Obstetrical emergency.
-Incidence :- Widely varies from 1 in 2000 to 1-200 deliveries. -Types :-
-1) Complete rupture : All the three layers of the uterus are involved.
-2) Incomplete Rupture: Peritoneum remain intact.
UTERINE RUPTURE
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.
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.
Localized tenderness and persisting aching pain over the area of the uterine
segment Bleeding into the peritoneal cavity
Swelling of the abdomen: Retracted uterus Extrauterine fetus Hemorrhage from torn
uterine arteries Bleeding to the vagina Decreased blood volume
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)
Violent Traumatic Rupture
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:
Deficient Fluid Volume related to active fluid loss from hemorrhage
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.
needed.
Keep the family members aware of the situation while the woman is in surgery and
allow time for them to express feelings.
Risk for Infection related to surgical incision
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
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 womans safety. Let the pt express her emotion
without feeing threatened.
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