Uterine Tear
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A uterine tear, or rupture, is a life-threatening obstetric emergency, which, if not attended to immediately, can lead to maternal and fetal death. The most common cause of a uterine rupture is previous uterine surgery, such as a Cesarean Section (C-section), and attempting a vaginal birth after cesarean (VBAC). Other risk factors include advanced age, prior removal of fibroid tumors, grand multiparity with oxytocic agents, malpresentation, second stage dystocia, cephalopelvic disproportion, or hydrocephalus (RNpedia, 2011). Symptoms include severe abdominal pain followed by diffuse pain and tenderness, and can lead to abdominal hemorrhage and fetal hypoxia if an immediate C-section is not performed (Medscape Reference, 2011). Bleeding may be profuse, or not evident in cases with placental previa.
From this clients admission data, it can be inferred that the patient is going into labor. Her contractions are regular, and she is at 38 weeks gestation. She was scheduled for an elective C-section the following week; therefore, it is an appropriate assumption that she would be in labor at this point in time.
The patients increased heart rate, drop in blood pressure, and cold, clammy skin are indicative of hypovolemic shock. These parameters indicate loss of blood, and inadequate perfusion of organs, which can lead to organ failure. Furthermore, the baby will be distressed due to an interruption in oxygen supply (BMJ, 2011).
Consequences of uterine rupture include uncontrollable abdominal hemorrhage, and part of the placenta, or even the baby, can enter the abdomen.
The patient may require a blood transfusion, extensive reparative surgery, or even a hysterectomy (Medscape Reference, 2011). The placenta can separate from the uterus and rapid fetal compromise can occur from the lack of oxygen supply to the fetus, as the mothers body tries to oxygenate her own organs.
When a patient has a uterine rupture, there is not much time to spare. The nurse is responsible for getting the surgical suite prepared for the immediate C-section, as well as preparing the patient for surgery. The nurses role includes monitoring the patients blood pressure, pulse, and respirations, as well as fetal heart tones (RNpedia, 2011). The nurse will start running IV fluids, obtain transfusing blood products, maintain a patent airway, oxygen administration, and foley insertion (Perry, 2010). Emotional support should be given to the patient and her family throughout the emergency.
The seriousness of the clients condition may have been anticipated if, upon admission, the staff was aware that the patients last delivery was a C-section which required a vertical abdominal and vertical uterine incision, and had required a ventral repair last year. This information would have raised a red flag for the possibility of uterine rupture.
When providing emotional support to the patient, the nurse should calmly explain uterine rupture, and how it can affect both her and her baby, as well as answer any questions she may have regarding her condition and the impending C-section. The nurse should also reassure the patient on the quality of care that is being provided for her, but be careful not to give her false hope, but to simply inform her honestly and competently about her condition, including the risks. Physical support is another nursing responsibility