possible to be ruptured and be closed?

[JadeRN7]

Hi we had a patient who was ruptured and not dilated at all. How is that possible? How does the amniotic fluid escape? thanks.

[bagladyrn, RN]

While the cervix is "closed" it is not solid. There is always an opening at the os. The amniotic fluid escapes the same way as menstrual flow does each month.

[Erin, RN]

An ectopic pregnancy is one that attaches itself somewhere outside of the uterus - amniotic sac, fetus, placenta and all. Since the pregnancy is outside of the uterus, it makes sense that there is no passage of anything through the cervix and lady parts with rupture. Instead, rupture involves injury to whatever organ the pregnancy has attached to. For example, if the pregnancy was forming in a fallopian tube and ruptures, that means the tube has burst open and that the woman is bleeding internally into her abdominal cavity. Usually, ectopics are identified within the first months of pregnancy because rupture occurs once the fetus has grown too big, so there's not much amniotic fluid to begin with. Although ectopics seem to be most common in the fallopian tubes, I've also had patients with ectopics attached to a cesarean incision or to a bladder in the women's ER. A ruptured ectopic is always such a scary diagnosis, as a matter of minutes can mean life or death for a woman based on how much internal bleeding she has before corrective surgery can be done.

In women who are very stable with very small, non-ruptured ectopics with no cardiac motion, we sometimes give Methotrexate instead of surgically intervening. This is a form of chemotherapy that basically dissolves the pregnancy. If women opt to receive this medicine, they must have someone with them around the clock who could call 911 or immediately bring them to the hospital if things take a turn for the worst until the med has proven to be effective in follow up appointments since rupture is still a possibility.

Hope this helps!!

[L&DRNJenn]

I think the OP is referring to rupture of membranes....those are my least favorite to admit. Ruptured and closed...and armed with a birthplan. Always feel so bad for them!

[Erin, RN]

haha! I'm ridiculous! .... proof that I've been away from L&D for too long. I see the word "ruptured," assume ectopic, and think "get ready for the OR" .... awesome. :)

sorry y'all

[2curlygirls]

I was! I ruptured in a spectacular fashion after a night of contraction every 5-7 minutes. After that, I went to the hospital and my contractions were 2 minutes apart! Got there and on exam I was "closed and firm". I had my daughter 16 hours and a bunch of pitocin later.

[Nire83]

Also remember that the cervix doesnt just move in one direction. Spictor reflex anyone? Often when a woman is in an enviroment where she doesnt feel comforable her cerivix can slam shut. Its quite possible that she was 3cms when her membranes ruptured, but during the exam was closed tight!

[bagladyrn, RN]

Also remember that the cervix doesnt just move in one direction. Spictor reflex anyone? Often when a woman is in an enviroment where she doesnt feel comforable her cerivix can slam shut. Its quite possible that she was 3cms when her membranes ruptured, but during the exam was closed tight!

Can you give me a reference for this phenomenon? I've never experienced a cervix closing up like that.

[Elvish, BSN, DNP, RN, NP]

Can you give me a reference for this phenomenon? I've never experienced a cervix closing up like that.

Ina May Gaskin mentions it in one of her books - I can't remember if it's in Spiritual Midwifery or Ina May's Guide to Childbirth, but she does recognize the phenomenon.

[vlynnieg]

We call the os 'closed' if we cannot find a discernable oepning with our fingers. However, i have had a rare few patients that were 'closed' and decidedly leaking fluid (and, yes, nitrazine positive) I have had some that I thought were closed, then realized the os was so posterior that even I with the longest fingers in the house could barely reach