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Chapter: Obstetric and Gynecological Nursing : Abnormal Labour

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Rupture of the Uterus

Definition: When there is a tear or cut in the uterus. It is one of the obstetric emergencies.

Rupture of the Uterus

 

Definition: When there is a tear or cut in the uterus. It is oneof the obstetric emergencies.

 

Causes

 

·        Weak caesarian section scar

 

·        Trauma during operative manipulation per vagina

 

·        The unwise use of oxytocic drug

 

·        Obstructed labour.

 

 

1. Weak Caesarian Section Scar 

Cause: -

- Wound healed by secondary or more of stage - If another pregnancy occurs with in six months

-   Over distension as in subsequent twin or ployhydraminos

 

Occurrence- During 1st stage of labour or the last four weeks of pregnancy.

Sign and symptoms

 

·        Constant abdominal pain accompanied by vomiting even when the pulse below 100.


·        Vaginal bleeding

 

·        Shock

 

 

Management

 

·        Labour should be conducted in hospital

 

·        Reduced abdominal palpation to a minimum and perform with great gentleness.

 

Observation: - Record and Report

 

·        Increased tenderness over the scar

 

·        Constant pain in the abdomen

 

·        Slight or no advance, with good contractions during 1st stage

 

·        Insufficient advance during 2nd stage

 

·        Arise pulse rate

 

·        Vaginal bleeding

 

·        Shock

 

2. Due to obstructed labour

 

Cause- When labour is obstructed it causes excessive thinning of the lower uterine segment during labour.It is more common during 2nd stage of labor

 

Signs and Symptoms

 

i.                     Rising pulse rate

 

ii.                     Tonic contraction and Bandl’s ring

 

iii.                     Tenderness of the lower uterine segment

 

iv.                     Vaginal bleeding

 

 

In case of actual rupture

 

·        Mother feel separate mass & some thing has given way and contraction cease

·        Cessation of FHB

·        Abdominal or shoulder pain 

 

Management:

 

On district:

 

·        Lay the patient flat, put IV drip

 

·        Pethidine 50mg for pain reliving

 

·        Treat for shock

 

·        Transfer to the hospital quickly

 

 

On Hospital

 

·        Lie flat, prepare blood for transfusion

 

·        Prepare for operation

 

 

3. Due to trauma

Cause:

-   Operative procedure

e.g internal version, craniotomy

·        Extraction of the after coming head of the hydrocephalus baby:

e.g Cervical tear

 

4.  Due to unwise use of oxytocic drugs

 

Cause - Using intravenously or intramuscularly to induce labour

 

 

Types of rupture

 

·        Incomplete rupture the myometrium and endometriumare ruptured and the perimetrium remains intact.

·        Complete rupture all uterine layers are torn. 

 

Management of a ruptured uterus away from hospital

 

i.                     Lie patient flat

 

ii.                     Take blood for grouping and cross matching

 

iii.                     Put up Intravenous drip & give pethidine 50 mg

 

iv.                     Transfer to the hospital

 

 

Management of a ruptured uterus in the hospital

 

·        Lie patient flat

 

·        Blood group and cross match

 

·        Put Intravenous drip

 

·        Get patient to sign consent form

 

·        Give pre medication

 

·        Carry out doctor’s order

 

Condition of the baby

 

·        Usually still born

 

·        Incase of incomplete rupture and if it happens in the hospital it is possible to have a live baby.

 

 

Management

 

·        Hysterectomy

 

·        Repair of the uterus if the it torn anteriorly

 

Postoperative care is the same with other postoperative cases.

 

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