UTERINE RUPTURE

Uterine rupture is a spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity. Most uterine ruptures occur when a pregnant person is in labor, but it can happen during pregnancy. Women who have previously undergone cesarean births and then tried for normal spontaneous delivery or vaginal birth are more likely to experience a uterine rupture. This is a rare but life-threatening complication that requires immediate treatment.

Uterine rupture could endanger both the mother and the unborn child's lives. This creates a hole in your abdomen and uterus. This can be very dangerous and cause severe blood loss. The fetus is left without your uterus's protection when your uterus ruptures. This can cause the fetus’s heart rate to slow down and leave it without oxygen. The fetus runs the risk of suffering brain damage or suffocation without oxygen. That’s why the fetus should be delivered quickly and repair the ruptured uterus.

A uterine rupture can be complete or incomplete:

Ø  Complete uterine rupture: The tear goes through all three layers of your uterine wall. This is very serious and requires immediate treatment.

Ø  Incomplete uterine rupture: The tear doesn’t go through all three layers of your uterine wall.

The rupture is complete when it goes through the endometrium, myometrium, and peritoneum layers whereas incomplete rupture leaves the peritoneum intact.

The contributing factors for uterine rupture are generally those that make the uterus inherently weaker which generally include:

Ø  prolonged labor

Ø  abnormal presentation

Ø  multiple gestations

Ø  unwise use of oxytocin

Ø  obstructed labor

Ø  traumatic maneuvers of forceps or tractions

 When uterine rupture occurs, fetal death will follow unless immediate cesarean birth can be accomplished. Uterine rupture can cause life-threatening complications but serious complications are less likely to occur with an immediate treatment.

Complications for the fetus:

Ø  Suffocation

Ø  Brain damage due to lack of oxygen

Complications for you:

Ø  Excessive blood loss (hemorrhage)

Ø  Losing the ability to get pregnant due to a hysterectomy

Ø  Stillbirth

There may be no visible signs of uterine rupture but your prenatal care provider will look for signs of difficulties during birth and will take action if they suspect something is wrong. Symptoms of uterine rupture could include:

Ø  Non-reassuring fetal heart rate (fetal distress)

Ø  Fast heart rate or low blood pressure in the pregnant person

Ø  Sudden and severe abdominal pain

Ø  Vaginal bleeding

Ø  Contractions that don’t stop or let up

Ø  Labor that stops or slows down

Uterine rupture is an immediate emergency. That’s why there is a need to administer emergency fluid replacement therapy as prescribed, anticipate the use of IV oxytocin to attempt to contract the uterus and minimize bleeding and prepare the patient for a possible laparotomy as an emergency measure to control bleeding and birth the fetus. Most patients are advised not to conceive again after a rupture of the uterus unless the rupture occurred in the inactive lower segment. At the time of the rupture, the primary care provider, with consent, may perform a cesarean hysterectomy (removal of the damaged uterus) or tubal ligation, both of which will result in loss of childbearing ability. Medical or Surgical Management includes:

Ø  uterine repair on one hand

Ø  uterine repair with bilateral tubal ligation (BTL)

Ø  hysterectomy

Ø  immediate laparotomy with cesarean delivery.

These are some of the nursing management on uterine rupture: monitor for the possibility of uterine rupture, assist with rapid intervention, prevent and manage complications, and provide physical and emotional support. The possible nursing diagnosis for this complication are: Risk for Maternal Injury, Risk for Fetal Injury, Risk for Fluid Volume Deficit, and Ineffective Individual Coping.

Expect at least four to six weeks to recover from a ruptured uterus. That’s why it’s important to follow the physician or nurse’s instructions on what to do and what to avoid until you’ve fully healed. This includes getting plenty of rest, avoiding lifting heavy objects, exercising and taking a walk, remembering to eat nutritious foods, monitoring your pain, taking a bath or sitting in water, and avoiding placing something inside your vagina.

The rapid increase in uterine ruptures in 2019 may be due to improved data accessibility via a local electronic medical database and the cumulative impact of other potential risk factors.

The incidence of symptomatic uterine ruptures at our tertiary referral center is similar to other developed countries, where the incidence of uterine ruptures ranges from 1.9 to 38 cases per 10,000 births. Maternal mortality due to uterine rupture is about 0–1.4% and stillbirths at about 12%. The incidence of perinatal mortality due to uterine ruptures in hospitals, where less than 3000 women give birth per year, is statistically significantly higher than at tertiary centers. 

Uterine rupture is a rare but serious complication that occurs most often in people who attempt a vaginal delivery after having had a C-section or other surgery on their uterus.  It's important to go over your medical history with your maternity care provider so they can choose the best plan of action for your delivery. It’s possible to have a vaginal birth after a previous cesarean provided certain criteria are met. Ask your doctor about your delivery options and whether you're at risk for uterine rupture. And most importantly, you should always take care of yourself and your baby.