Uterine rupture & maternal code

[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 lady parts), 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

[Schmoo1022]

Hi there,

This is a little off subject. I am due to have my second c-section on March 29th. I decided against a vbac due to the fact that my babies are going to be 17 months apart and I am not sure of how healed my previous c-section scar is.

I have been asked multiple times with this baby if I want my tubes tied. I feel like I am being pressured. Would it be way too risky to have THREE c-sections?? I am not even sure if I want a third child, but I feel like they are pushing me into getting my tubes tied!!

Any input?

[mumofbratz]

Hi there,

This is a little off subject. I am due to have my second c-section on March 29th. I decided against a vbac due to the fact that my babies are going to be 17 months apart and I am not sure of how healed my previous c-section scar is.

I have been asked multiple times with this baby if I want my tubes tied. I feel like I am being pressured. Would it be way too risky to have THREE c-sections?? I am not even sure if I want a third child, but I feel like they are pushing me into getting my tubes tied!!

Any input?

If I were You i would talk to your Dr. about what he thinks aobut the situation. I just had my fourth c-section 3 days ago with no complications and i had asked my Dr. after my third one of it would still be ok to have more children and he said that ever case is different and some women can have 6 or more c-sections just fine while others should really stop at just 2 because their bodies can't handle it.

[sirI, MSN, APRN, NP]

Hi there,

This is a little off subject. I am due to have my second c-section on March 29th. I decided against a vbac due to the fact that my babies are going to be 17 months apart and I am not sure of how healed my previous c-section scar is.

I have been asked multiple times with this baby if I want my tubes tied. I feel like I am being pressured. Would it be way too risky to have THREE c-sections?? I am not even sure if I want a third child, but I feel like they are pushing me into getting my tubes tied!!

Any input?

Hello, Schmoo1022,

You need to get in contact with your OB and ask these questions.

The members of Allnurses.com cannot give you any medical advice regarding this.

Please call your OB and pose these questions/concerns to him/her.

Good luck with your pregnancy and delivery.:)

[ladytraviler]

I remember a G6P5 in to deliver her last child. When she started pushing she started complaining of pain in the abdomen. No previous abdominal surgeries or anything. The baby was crowning, the doc gloving, warmer on, and the other nurse documenting. We all looked at the perineum and the baby was gone. The doc thought we called to early but then baby started having sig decels. Had to vaccum the baby from a -2 station due to no sx team.

Found out an hour after delivery that the uterus had split in a classical incision. The only way found out was she kept c/o pain in abdomen and abd was getting rounded and firm. talk about scarry. the MRI showed a uterus no where but a abd full of blood. The thing that made this so bad was the patient was non english speaking and we did not have an interpreter as she progressed so fast.

Baby intubated and mom uninterested at that point. Both made it but was a close call.

[sirI, MSN, APRN, NP]

I remember a G6P5 in to deliver her last child. When she started pushing she started complaining of pain in the abdomen. No previous abdominal surgeries or anything. The baby was crowning, the doc gloving, warmer on, and the other nurse documenting. We all looked at the perineum and the baby was gone. The doc thought we called to early but then baby started having sig decels. Had to vaccum the baby from a -2 station due to no sx team.

Found out an hour after delivery that the uterus had split in a classical incision. The only way found out was she kept c/o pain in abdomen and abd was getting rounded and firm. talk about scarry. the MRI showed a uterus no where but a abd full of blood. The thing that made this so bad was the patient was non english speaking and we did not have an interpreter as she progressed so fast.

Baby intubated and mom uninterested at that point. Both made it but was a close call.

You were witness to classic s/s uterine rupture:

1. severe acute px (abdominal, shoulder or back)

2. loss of fetal station (once 0 has now progressed to a higher station)

3. profound change in fetal heart tracings

There are other signs/symptoms and you may have witnessed those as well.

[JentheRN05, RN]

The abdomen getting round and firm after the change in station I think would've been the kicker for me, with the other s/s of course.

[ladytraviler]

Her abdomin didn't get firm and round until about an hour after delivery. We sent for a MRI cause she wasn't bleeding at all after delivery. The spouse just kept saying she hurt. I was not her nurse, I was the baby nurse and really had my hands full trying to stabilize him. He had seizures and was on a vent.

[Mimi2RN, ASN, RN]

We had a c/s where the uterus was ruptured, baby's upper body was in the abdomen when the doc opened her up. The surprising thing was that the placenta was still attached, there had not been a lot of bleeding, and the baby came out alive and did well. I don't remember if mom had a hysterectomy or not, as I do the babies, not the moms.

We had another one after mom used methamphetamine, no PNC. That baby came out alive, too. Mom had multiple units of blood, and did NOT have a hysterectomy. Next time it will kill her......

[NurseNora, BSN, RN]

The "windows" I have seen at C/S were usually just the uterus stretched very thin. But I have seen the uterus open along the old scar and the window was the intact bag of water. Scheduled repeat C/S, no pain, no fetal distress, no idea until the belly was opened.

[elliebellie]

I had a patient a few months ago who had a successful VBAC, some severe variables the last 5 minutes but she was complete & delivered a few minutes later. She was stable in recovery, breastfed, no pain or bleeding & then we went back for a routine PP tubal. Discovered vernix in her abdomen.

She ended up having a hysterectomy & several units of blood.

[wannabeL&D73]

Although I strongly believe that women should have the right to make an informed choice for VBAC, this thread has firmly reinforced my decision to do a scheduled repeat c/s in a future pg. Very scary stuff.

[Altalorraine]

Although I strongly believe that women should have the right to make an informed choice for VBAC, this thread has firmly reinforced my decision to do a scheduled repeat c/s in a future pg. Very scary stuff.

You'd be better off making an informed decision based on statistical risk rather than anecdote. C sections can have frightening consequences too.

Altalorraine