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.
You'd be better off making an informed decision based on statistical risk rather than anecdote. C sections can have frightening consequences too.
Altalorraine
Thank you for your concern. I did make the intial decision based on statistical risk given my own particular history. The anecdotes merely served to reinforce my prior informed decision.
Thank you for your concern. I did make the intial decision based on statistical risk given my own particular history. The anecdotes merely served to reinforce my prior informed decision.
I'm glad to hear that you did your homework. Choosing a surgical birth, with it's attendant very serious risks, is too momentous a decision to have it be based on anxiety and scare stories.
I'm glad to hear that you did your homework. Choosing a surgical birth, with it's attendant very serious risks, is too momentous a decision to have it be based on anxiety and scare stories.
You'd be better off making an informed decision based on statistical risk rather than anecdote. C sections can have frightening consequences too.
Altalorraine
So true. Anecdotes have to be taken in context. Horror stories tend to be memorable and oft repeated. 4 mths into L&D and c/section's have already scared the sh*t out of me.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
The thing about rupture, is while rare, it's nearly always catastrophic. It's not merely a "scare story" we are discussing here. It's a real risk. For some, it's unacceptable.
If I can be philosophical here, loss and trauma is undesirable regardless of how it affects the sensory receptors of the nurses. As far the pts, the outcome is what's important. It's bad or it's good. There are bad consequences to c-sections which don't shock our senses - such in infection, bleeding which leads to risks of transfusions, and PE. Therefore the outcome statistics is what should be considered in the best interest of the pt. when making a decision.
Sorry, for the rant - carry on as usual, I'm learning a lot.
The thing about rupture, is while rare, it's nearly always catastrophic. It's not merely a "scare story" we are discussing here. It's a real risk. For some, it's unacceptable.
We are scrupulous about not giving out medical advice here, but a bunch of nurses telling their worst "ruptures I have seen" stories gives a frightening impression to a casual, uninformed reader of what the actual risk is (risk is about 1 in 500- that's not 1 in 500 women, it's 1 in 500 times a woman with a scar would have to give birth lady partslly in order for it to result in a rupture). We already know that people read these boards hoping for advice. A thread of sensationalist stories needs some grounding in numbers, in my opinion. People should do their homework, and we should watch what we say, making sure it is based on fact (i.e. ACOG recommends a trial of labor for most low-risk women in consultation with their doctors), not opinion.
If I can be philosophical here, loss and trauma is undesirable regardless of how it affects the sensory receptors of the nurses. As far the pts, the outcome is what's important. It's bad or it's good. There are bad consequences to c-sections which don't shock our senses - such in infection, bleeding which leads to risks of transfusions, and PE. Therefore the outcome statistics is what should be considered in the best interest of the pt. when making a decision.
Sorry, for the rant - carry on as usual, I'm learning a lot.
I agree; we have become desensitized for certain kinds of risks; that which is familiar and perceived to be controllable doesn't scare us as much (people who would never risk a VBAC will place their precious infant in an automobile for the ride home or for a ride to Grandma's house- has anyone checked on the risk of accident?).
Of course we could start a "hemorrhages I have seen" or "bowel perforations after c section" thread to try to give some balance.
We are scrupulous about not giving out medical advice here, but a bunch of nurses telling their worst "ruptures I have seen" stories gives a frightening impression to a casual, uninformed reader of what the actual risk is (risk is about 1 in 500- that's not 1 in 500 women, it's 1 in 500 times a woman with a scar would have to give birth lady partslly in order for it to result in a rupture). We already know that people read these boards hoping for advice. A thread of sensationalist stories needs some grounding in numbers, in my opinion. People should do their homework, and we should watch what we say, making sure it is based on fact (i.e. ACOG recommends a trial of labor for most low-risk women in consultation with their doctors), not opinion.
Altalorraine
I realize there are lots of people reading this forum looking for advice, but I personally am not a casual uninformed reader...I am a nursing student and a mother of 2 and I have discussed this issue at length with my OB and MFM. And I really believe that anyone looking for information on this forum is intelligent enough to make the decision based on facts compiled from many different sources.
I realize there are lots of people reading this forum looking for advice, but I personally am not a casual uninformed reader...I am a nursing student and a mother of 2 and I have discussed this issue at length with my OB and MFM. And I really believe that anyone looking for information on this forum is intelligent enough to make the decision based on facts compiled from many different sources.
As I said, I'm glad you're informed. Good luck to you.
We are scrupulous about not giving out medical advice here, but a bunch of nurses telling their worst "ruptures I have seen" stories gives a frightening impression to a casual, uninformed reader of what the actual risk is (risk is about 1 in 500- that's not 1 in 500 women, it's 1 in 500 times a woman with a scar would have to give birth lady partslly in order for it to result in a rupture). We already know that people read these boards hoping for advice. A thread of sensationalist stories needs some grounding in numbers, in my opinion. People should do their homework, and we should watch what we say, making sure it is based on fact (i.e. ACOG recommends a trial of labor for most low-risk women in consultation with their doctors), not opinion.
Altalorraine
Maybe I am wrong...but I dont thimk this site is appropriate for "casual and uninformed" readers. Those readers would probalby not understand the terminology used here. Point being, I think we are all professionals or at least some what knowledgeable about this topic. By the way, I am glad I found this thread...I am currently 5 months pregnant with twins, with a 14 y/o csection. I had nonknowledge of this condition ( I am Renal/Transplant/ Dialysis nurse) now I have something to research and question my perinatologist about. Sometimes you have to take the good with the bad...meaning the threads. But, I do appreciate all views.:) :)
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
We are a board of nurses discussing our experiences here, not giving medical advice, Alta Lorraine. Therefore, anyone reading this and taking it for medical advice need beware. We are discussing professional experiences here; in no way should that be taken for medical advice, clearly.
And as to the rarity, yes it is rare. However for some, a 1/100 chance of catastrophic rupture (in certain VBAC cases, this IS the quoted risk)---- is unacceptable. After being educated as to the risks and benefits of going VBAC versus repeat csection with their physicians and/or midwives, patients must make up their own minds and sign informed consents.
But we also must be aware of something very troubling as professionals: that consent is not worth the paper it's printed on in court, in certain cases. I personally know of a few nurses who have been in court that can tell you stories that would stand your hair ON END.
That said, I will caveat this by saying:
No one should take the words/anecdotes here as medical advice or information. It's critical each patient work with her personal HCP to find what best options exist for her and her baby.
Ok out of here, this was not intended to be a VBAC debate thread, after all.
wannabeL&D73
110 Posts
Thank you for your concern. I did make the intial decision based on statistical risk given my own particular history. The anecdotes merely served to reinforce my prior informed decision.