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.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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.
Altalorraine
Yes we could and perhaps LEARN from one another. Nothing at all wrong with that, as far as I am concerned, Altalorraine.
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.
Yes, it should be clear, but it isn't always; hence, my post.
Ok out of here, this was not intended to be a VBAC debate thread, after all.
No one debated VBAC; facts were presented to accompany the anecdotes. Threads tend to live or die based on whether people are interested in discussing what other people post. No one is ever obliged to respond to anyone else's posts.
Specializes in Education, FP, LNC, Forensics, ED, OB.
Altalorraine, I thought I'd chime in here in defense of Smilin's remark about the "VBAC debate". I do believe she meant that her remarks were not to be intended to be a VBAC debate, not the thread itself.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Thank you, that is what I meant, Siri. I am just trying to keep on track here. These threads often digress (and I have been guilty of that myself) and VBAC debates do get quite heated (like other hot-button issues).
And I will still say, if a board of professionals wishes to discuss issues like this, and others who visit read this, try and take it for medical advice, we can't stop them. However, it's very clear in our terms of service, medical advice is neither to be asked nor given on allnurses.com. That should be made clear to everyone who visits and participates here.
So, let the discussion of professional experiences continue here, and may we all learn from them!
I havent seen a code d/t rupture (*knocking on wood..*), but we had a code d/t amniotic fluid embolus. wasnt my pt, but i think she went into DIC... the whole nine yards.. sad situation, but both mom and baby lived!
I never meant to start this thread as a VBAC discussion. However, I've been following everyone's responses.
Let me clarify one thing - the mom I stated in the original post did not have a prior c/s or uterine incision. She was a vag del x3, who labored at home and came in with an IUFD, 10cm dilated, in compound presentation, with a uterine rupture, probably from a transverse lie during labor.
This was is no way to blast on homebirth moms either. Some more background info on this mom, that I later found out, she is a member of a particular faith who believes that all medical intervention is the devil. Her family did not call 911 - she called 911 - after laboring for at least 2 days, and with a fetal arm hanging out of her lady parts for almost a day.
We are still upset about this at work, that a woman could put her faith before her unborn child's life. However, she is the one who has to live with the consequences now.
I was simply looking for any other cases of uterine rupture, with or without maternal code. I know it's very rare, and I didn't expect to see too many other cases.
Maternal codes have always been a big concern in the back of my mind - whether it be from an amniotic fluid embolus, uterine rupture, etc. Ironically, we had just reviewed maternal codes where the fetus is still in the uterus a few months ago in our annual OB competencies. I remember commenting "I hope I never have to see one of those", but looking back, I'm grateful for the experience, and want to learn as much as I can from it, should it ever happen again.
What a tragic, tragic story. How absolutely heartbreaking, I can't imagine living with the knowledge that I didn't get help for my baby.
Anyway, sorry to take this thread on a tangent, I am the one who made the VBAC comment. I have comforted a friend through a full-term loss due to a rupture and so it became very personal for me.
But I think the shared information is valuable and hopefully will help another nurse in a similar situation one day.
Specializes in Education, FP, LNC, Forensics, ED, OB.
In teaching my ACLS EP classes, I incorporate obstetrical emergencies including ruptures, amniotic emboli, DIC, abruptions, praevias, etc. I try to impress upon each participant the need for judicious assessment and rapid intervention.
The statistics may be low on each of these tragic and horrible events in OB, but to recognize only one and have a favorable outcome for mother and baby is to seek the ultimate goal of excellence.
SmilingBluEyes
20,964 Posts