Uterine rupture & maternal code

fergus51 · Jan 19, 2006

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

Editorial Team / Admin · Jan 19, 2006

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 · Jan 19, 2006

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 · Jan 20, 2006

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 · Jan 20, 2006

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 · Jan 20, 2006

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 · Jan 20, 2006

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 · Jan 20, 2006

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, ASN, RN · Jan 20, 2006

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.

NurseNora, BSN, RN · Jan 21, 2006

I've seen 2 uterine ruptures, both previous sections attempting VBAC. The first one was atraumatic for the mom. She felt no unusual pain and was sectioned for failure to progress. At delivery, the separation along the old scar was seen. No large blood loss. The baby was stillborn, but that was not related to the rupture.

The second rupture resulted in a healthy baby without problems. The mom had a very different presentation however. She had intractable pain, unreleived by epidural. No large blood loss, or problems during or after surgery.

In the hospital where I used to work, it was common practice to schedule sections at 41 weeks to avoid delivering preterm babies and to allow the woman to go into labor spontaneously and attempt a VBAC. We could do sections quickly and at any time of the day or night (a necessity for doing VBAC anyway). It was very common to see a "window" in the uterus at the time of section.

When the rupture occurs at the old scar site, there often isn't a large amount of bleeding or pain. When the rupture occurs in the fundus of the uterus, there will be a lot of both

Sis123 · Jan 21, 2006

NurseNora, thank you for your reply to this thread. You stated:

"It was very common to see a "window" in the uterus at the time of section. "

Could you please elaborate on this? Was this window a small tear, or a transparent area?

thanks!