Have you ever had a patient with a uterine rupture?

bignursenancy · Sep 30, 2006

It is absolutely the worst thing that can happen to you as a l/d nurse. I had one that had a previous c/section and came into l/d with 2nd preg, full term, in labor and 6cm. Doc came in to get epidural placed. Sat her up, laid her down, and I couldn't find FHR. I immediately called out to the doctor at the desk and told him I thought we had a ruptured uterus. He came in and we rolled stat to c/section room. Almost lost mom and baby at that time. Mom lived and baby did not make it (died a few weeks later). Again, that will live in my mind forever.

Our docs rarely do VBACS around here anymore. They tell most of the patients, I will be proud to reccomend a doctor that does them, but I don't perform VBACS anymore. Liability is just too high.

Good luck with your research.

emllpn2006 · Sep 30, 2006

I knew a woman who had a rupture after her second birth lady partsl birth. The father noticed she seemed to be acting different and was bleeding alot. It was his first birth experiance. He asked the nurses if something seemed wrong. They assured him it was perfectly normal to act that way after delivery. When they went to transfer her from the delivery room to the mother baby post partum rooms the bed was full of blood underneith of her. They ran over 80 units of blood through her on the way to surgery and afterwards. She did survive but unfortunalty had suffered brain damage and doesnt remember being pregnate of having the baby. She claims the child is not hers she doesnt know where it came from and lives in a ltc facility.

mitchsmom · Oct 1, 2006

I am a new L&D nurse (2.5 mos) but we had one just last week, wasn't my pt and I don't know the details but she was a repeat c/s who came to the unit in labor, so she went quickly for c/s anyway and it was discovered in the OR.

As far as I know it all turned out ok - they must have luckily been cutting her pretty close to the time it happened b/c I don't think there were any signs of rupture before entering the OR.

tdr61 · Oct 2, 2006

In my 16 years of L&D nursing I have seen two uterine ruptures (neither were my patients). One was a VBAC attempt, not induced or augmented, delivered lady partslly and ruptured during the immediate recovery phase. The patient was sent to the OR twice and received close to 100 units of different blood products and a hysterectomy. She spent several months in rehab to learn to walk and talk again but did survive. The other was a previous c/s who presented with contractions, non-english speaking, no prenatal care, previous c/s in Mexico with a vertical skin incision. The MD on-call took a "wait and see" attitude, the patient contracted irregularly for about 4 hours, got up to go to the bathroom and on the way back to bed the patient went to her knees doubled over, the staff got her to bed and on the EFM, FHR flat and in the 50's, rushed to the OR where she had ruptured, delivered an 8 lb girl with no EEG activity and kept alive on a vent, mom ended up with a hysterectomy at 20 years old. Upon mom's discharge the vent was turned off and the baby died.

Just last week I had another non-english speaking patient who presented to L&D with c/o lady partsl bleeding and abdominal pain. Prenatal care was through a local clinic so she was assigned to the ER OB doc on call. Through a translater I found she was a previous c/s x2, she had a moderate amount of bright red lady partsl bleeding, severe abdominal tenderness, uterine hyperstimulation and a maternal HR in the 120's. A stat c/s was called and when they opened her up they found her lower uterine incision was rupturing and she was bleeding into the myometrium...the entire uterus was mottled. She was also abrupting. Mom and baby came through without incident.

Good luck with your research!

CMCRN · Oct 2, 2006

My personal experience with a rupture, what struck me the most was she had so much pain despite having an epidural, all on the right side which is where she had ruptured when we opened her up and found the baby out of the uterus. They both made it. In years past when we very agressively pushed VBACS we had many ruptures. But we have had at least 3 ruptures that were in uncomplicated multips, not Vbacs. One of those was also my patient, and she didn't make it. We had an easy delivery but her Dr thought she had a vag wall tear and kept trying to stitch that, she had ruptured the back side of her uterus and bled out into the omentum so minimal blood seen externally. She had wanted a PPTL, but they never thought her stable enough to do it, I kept thinking afterwards if we had just done it they probably would have found the rupture. She coded on the next shift. The baby was fine.

SmilingBluEyes · Oct 2, 2006

Have seen a couple. What was scary about one was there were no sx whatsoever. She had a c/section due to nonreassuring fht and non-progress, and LO there was a nice window in the lower segment, through which a fetal elbow presented.....scary yea. When you have no idea it's there and to think what could have happened. Oh and this was NOT a VBAC.

Also had one w/lady who had had several prior c/s, scheduled csection, and same thing, no sx. Was in for routine repeat c/section. Surgeon opens, and eek, there is a teeny tiny window. Scary enough, also.

One thing I remember so clearly from some years back, is a woman who had had lots of babies and repeat sections, again, having another sched. section. NO rupture, no, BUT a uterus so thin, it was transparent. The mom wanted to have more babies----but dad was on the fence. The surgeon showed the dad her uterus, paperthin,literally...what a visual.......and pointed out why they should probably not have more kids. He agreed and later, the mom was told. I hope she was willing to listen. That was one dramatic clinical picture.

Another involved a patient I never met, but was in a unit in which I worked some years ago. She was only 16 and a primipara. Lost her uterus but baby lived, and so did she. BIG lawsuit ensued. I have no clue how it turned out, in the end. SAD SAD case.

Ruptures are rare, thankfully. But remember, they don't necessarily present with any set routine signs/symptomology. Some have NO apparent s/s other than fetal heart tones that become a bit problematic. No pain, no bleeding, no dramatic changes in FHR patterns, at least right away.

The lesson is if/when you suspect rupture, you must act extremely quickly. Minutes mean lives.

OH and before I forget, none of the cases I recall involved TOLAC/VBAC at all. These were either nonlaboring repeat c/s or laboring moms w/o prior hx of uterine surgery whatsoever.

dmv0309 · Oct 2, 2006

This is my story. Had my DD in 99, was breech, she was a C/Section, drs found I only had 1/2 of my uterus. DS due to be born in June 2002, ALL male drs in practice recommended C/Section, I DID NOT WANT A VBAC. The week before my C/S, the woman dr who was going to deliever(it was her day) tried to talk me into VBAC, gave me all the statistics about how low the risk was for a VBAC, I declined and went with C/S. As she was delievering my son, she made teh comment "glad you are having a C/S, your utuerus is so paper thin, you would have likely ruptured" Good think I went with my instincts.

Denise

33-weeker · Oct 14, 2006

the one uterine rupture i knew the stats on was a g3/p2, attempting second vbac (first vbac successful). she came in and got an epidural, which slowed her contractions, so then pitocin augmentation was given. when it came time to push, she wasn't pushing effectively.

the doc had forcepts sitting right on his table, but didn't like to use them. he ordered fundal pressure instead. the mother indicated it hurt (through the epidural - that was so strong she couldn't push - hellooo!). they let her try again. fundal pressure was ordered again. her uterus ruptured.

i caught the baby after a stat section. i truly thought i'd been handed a dead baby. apgars something like 1:4:7. didn't even try to gasp until nearly 10 minutes old. the baby went to level ii, but was off the vent later that afternoon. went home doing well - big term 8-pounder as i recall.

the ob spent hours sewing mom's uterus back together, only to tell her not to get pregnant again. :nono:

some places don't allow pitocin for vbacs, some don't even allow epidurals. i have mixed feelings about vbacs. but the problem isn't really the vbacs. the problem is not preventing the original c-section in the first place.

if i had a dollar for every woman who vbaced a bigger baby the the c-section baby she was 'too small to deliver', i'd be a rich woman and wouldn't have to work.

SmilingBluEyes · Oct 15, 2006

The latest ACOG bulletin about TOLAC/ VBAC should be mandatory reading for ALL Nurses who care for patients undergoing VBAC/TOLAC. It really discusses risks, benefits and conditions under which TOLAC ought or ought NOT be undergone. And it discusses when pitocin is and is not appropriate. I find it most helpful. It's what our TOLAC policy where I work is entirely based upon.