In the right place at the right time........

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Pt presents at 0130 with c/o ctns since 2230. States she is hoping fror a VBAC. Pt appears uncomfortable with ctns, but tolerating well. EFM placed at 0138, good baseline with avg LTV, ctns q 2 min. Sve 2 /90/-2. Paged doc to BS for exam, Ok for epidural when pt desires (which is now!). at 0155, coaching pt & getting IV supplies ready. 0200 pt begins to scream and I KNEW her uterus ruptured, attempt to call for help and Start IV, o2. FHR 60's. In OR at 0205, and by the grace of God 2 MDs and anesthesia present (small hospital) Infant delivered at 0212, apgars 1,6,9 thanks to awesome baby nurses. Home with mom in 4 days. SOOOOO many things could have gone wrong, but everything clicked into place. If she had waited 30 more min to go to the hospital it would have been a very bad outcome.

We all see (or will see) these rare complications in our career. It just makes me believe in a higher power guiding these pts to us and guiding our hands when we care for them.

Another interesting tidbit... the pt said (this is after the c/s) that she felt 2 "pops" in her lower abdomen about 2 1/2 hrs before she came in. Also the tracing was very interesting and frightening. When she ruptured fhr was 150's with a sudden break then resumed in the 60's. I was at the bs, so I could hear it was fetal but on the monitor it looked like maternal was picked up (you know when they sit forward etc...) .

Had my adrenaline going, I didn't need any more coffee that night!

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Specializes in ER.

Amazing

You did a wonderful job- you saved two lives!

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I am glad to hear that there can be positive outcomes when this happens. We are a small rural hospital and have lost out OB unit over a similar situation. We had only been up and running a few months when a mother came in having a Vbac (which she said the doctor talked her into). She had gotten her epidural then ruptured however the nurses thought the drop in blood pressure was from the epidural, finally when the fhr dropped they realized it was time for the surgery. When they got the baby out they could not get it to breathe so when attempting to intubate they blew both o the baby's lungs. Momma went home with a basket of flowers and a hysterectomy...later she received a big check and our ob unit closed. We did find out the hard way that the doctor had numerous charges and suits filed against him for malpractice and now is removing moles off of peoples neck in another city.

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Wow, (to the OP) way to be right on the ball. I know that generally VBACs are perfectly safe, but they make me very nervous for this reason.

The epidurals scare me the most with these pt's - will they still feel the rupture if they have a heavy block, or is your first clue FHT's in the 60's?

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Specializes in L&D.

The epidurals scare me the most with these pt's - will they still feel the rupture if they have a heavy block, or is your first clue FHT's in the 60's?

I've seen two ruptures with epidurals. One did not feel the rupture. Her baby had already died from other causes.

The other one had a good block, but felt the rupture. FHT's never went to the 60's. Stayed normal rate with good variability. Mom's VS stayed WNL. Her only symptom was pain that could not be relieved. She got repeated boluses of epidural meds, with relief lasting only about 1/2 hr or less each time. And a supra pubic buldge that suddenly appeared after the 3rd or 4th top off. Good baby, healthy mom who kept her uterus but never tried for a VBAC again.

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I have read that epidurals do not always mask a uterine rupture. This pt did not have an epidural yet, she was only on the monitor for 22 minutes and I was getting ready to place the IV.

Fht's were down and stayed down in this case because the placenta was in the abdomen when they opened her. I guess in the case posted above, if the placenta is still perfusing and baby is still in the uterus then it would be a very hard diagnosis.

Another nurse I worked with had a uterine rupture at some time during the spinal, pt without symptoms and already on the OR table . Baby was in the abdomen when they opened her and stillborn. They had good FHT's prior to spinal. Thet were doing a repeat c/s for FTP. VERY scary stuff.

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I am a noc nurse in a small hospital. We don't have in house MDA's/CRNA's 24/7, even if there is a VBAC in labor, but they are 'readily available' from home. All I can say is thank heaven for the angel that seems to sit on our shoulder at times and the OBs that listen to us when we tell them we don't know why, but it just doesn't feel right. Generally a good strip, but don't have a good feeling about it, etc... Have attended an emergency c-birth where the baby was already in the abdomen, but did well.

I had two c-births followed by 2 VBACs and fully support a woman that wants a TOL, but I would feel a whole lot better if I could make up a bed for the OB and MDA to stay the night while they labored.

BTW, congratulations on a job well done!!!:yeah:

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