[RNLaborNurse4U]

How many of you have seen a true uterine rupture, with or without maternal code blue?

We recently had a case of a mom who had no PNC, trying to deliver at home, with a compound presentation (arm and head - arm is out of the vagina), who presented to our ED. Scanned, showed a cavity full of blood, suspected abruption, no heart tones. Brought up to us to our OR, where she goes unresponsive on the way, and is coding on arrival to our OR. (Guess who's the scrub nurse? moi.)

When she was opened, she was found to have blown out the top of her uterus, with a massive uterine rupture, complete abruption, infant dead. Meanwhile, the code team is trying to resuscitate the mother.

The outcome: baby is dead. Mother is resuscitated, hysterectomy performed, she lost basically all of her blood and had it all replaced, plus over 12 units of FFP. Transfer to the ICU, where post op day #1 she is extubated and sitting up, talking, and playing cards with her family.

Amazing outcome for mom......poor for baby.....with a scrub nurse who hopes to never have to see something like this again.

I have been in L&D for 4 1/2 years, and this is the first uterine rupture I've seen, and first maternal code blue.

Jen
L&D RN

[fergus51]

I've seen it. It was actually when I was precepting. It was bar none the scariest moment in my life.

[sirI]

Unfortunately, I have been witness to several in my years of experience as OB/GYN NP.

I've seen frank complete rupture secondary to blunt force trauma post MVA. In pitocin inductions of multips. TOLAC's. Multiple gestations. And, most commonly the rupture after classical section before the onset of labor.

A horrible experience not only for the gravida and the fetus, but, the health care team as well.

Bless you, RNLaborNurse4U. {{{{HUGS}}}}

[SmilingBluEyes]

I have seen it only once in 8 years (hope never to see it again)

Saw an occult rupture---that's right OCCULT. Happened when a gal presented for labor who had had a prior csection but had no PNC w/our docs and we had no record of her prior birth or access to it. The doc on call said, " I dont' like this---there is no way I am doing a VBAC for someone I know squat about; set up for csection and I will be in to talk to her". She really wanted a VBAC (and we do them for the right conditions). Anyhow, baby looked ok on monitor----nothing dire at all---few variables and a late or two, but good overall variability and normal rates.

Doc gets in, we go back for csection and LO! there is a window where the uterus is beginning to rip wide open---seems she had had a prior classical incision, after all. Doctor's instincts were right-on and he handled it with such cool and calm, but he did sweat a lot.

Had this been "sat on" any longer, I am sure the cataclysmic situation above would have been a repeat in this story---but it was not, thank Goodness. Mom and Babe were fine.

Also had this same doc open up a patient for routine csection (cant' remember WHY she was having csection---think baby was breech) and you could SEE THROUGH HER UTERUS---like it WAS TRANSPARENT---the myometrium was like PAPER. That was a good scare for us all too....

Sometimes, it's just dumb luck that either saves or takes lives.

I am so sorry for what you saw and went through. Sorrier, still, for that woman who lost her baby and all future fertility. So sad...Uterine rupture, while rare, is just a horrible thing to deal with.

[midwife2b]

I am worried that we will see MORE uterine ruptures now that VBACs are being limited.
Had a horrible situation recently where a G3 P2 with 2 previous C-births tried to have a homebirth. SEVERE shouldere dystocia, 11 + lb. baby who couldn't be resusitated. Patient just didn't want a repeat CS and decided on a homebirth. (You have got to wonder what midwife in her right mind would take this patient as a client...)

[SmilingBluEyes]

You are right; many places don't do VBAC at all. Most of the hospitals in my area no longer do under ANY circumstances, unless baby is ready to come when they s how up. It's an insurance/liability and anesthesia 24/7 in-house coverage issue most of these places.

[jwk]

Originally Posted by midwife2b

I am worried that we will see MORE uterine ruptures now that VBACs are being limited.
Had a horrible situation recently where a G3 P2 with 2 previous C-births tried to have a homebirth. SEVERE shouldere dystocia, 11 + lb. baby who couldn't be resusitated. Patient just didn't want a repeat CS and decided on a homebirth. (You have got to wonder what midwife in her right mind would take this patient as a client...)

Allowing someone to even contemplate a VBAC in that situation is malpractice, and you have the bad outcome to prove it.

[Sis123]

Deb, I remember you telling us about the transparent uterus. It was a c-section where the woman was having her 14th(?) child after her OB doc told her to not have anymore. I remember you or the doc showing the husband the uterus, and he said that they would not have anymore or something like that.

Too bad for the woman in the OP's story. She not only lost her babe, but any future babes, too.

[SmilingBluEyes]

YEP that was it....you reminded me of the specifics of the case. ....... That was that case where the woman insisted she was having more kids and the dr silently pointed to the uterus for the husband who saw w/his own eyes what words could not convey. It was something ELSE. I do believe they are done having kids! Thanks for reminding me of the specifics. I just remember the transparent uterus. It was something else.

[DutchgirlRN]

When I worked OB/GYN we had a uterine rupture, during an attempted VBAC, Mom coded at delivery & died, baby girl lived, horrible experience. The father is a dentist who is now raising 2 little girls by himself.