Uterine Rupture Nursing Management

Notes

Uterine rupture in the lower uterine segment.

Description
  1. Uterine rupture is tearing of the uterus, either complete (i.e., rupture extends through entire uterine wall and uterine contents spill into the abdominal cavity) or incomplete (ie, rupture extends through the endometrium and myometrium, but the peritoneum surrounding the uterus remains intact).
  2. Small tears may be asymptomatic and may heal spontaneously, remaining undetected until the stress and strain of a subsequent labor.
Etiology
  1. Traumatic uterine rupture may be caused by injury from obstetric instruments, such as uterine sound or curette used in abortion.
  2. Rupture also may result from obstetric intervention, such as excessive fundal pressure, forceps delivery, violent bearing-down, tumultuous labor, and fetal shoulder dystocia.
  3. Spontaneous uterine rupture is most likely to occur after previous uterine surgery, grand multiparity combined with the use of oxytocic agents, cephalopelvic disproportion, malpresentation, or hydrocephalus.
Pathophysiology
  1. The most common pathologic factor is a pre-existing scar that results in a weakened or defective myometrium that does not stretch; this is most frequently identified in spontaneous uterine rupture.
  2. Some episodes of rupture are due to traumatic disruption of the uterine surface.
  3. More severe ruptures pose the risk of irreversible maternal hypovolemic shock or subsequent peritonitis, consequent fetal anoxia, and fetal or neonatal death.
Assessment Findings
  • Clinical manifestations vary from mild to severe, depending on the site and extent of the rupture, degree of extrusion of the uterine contents, and intraperitoneal evidence or absence of spilled amniotic fluid and blood.
  1. Abdominal pain
  2. Vaginal bleeding (may be present but is not always)
  3. Nonreassuring fetal heart pattern
  4. Palpation of fetal parts under the skin
  5. Signs of hypovolemic shock (with complete uterine rupture)

Nursing Management

1. Monitor for the possibility of uterine rupture.

  • In the presence of predisposing factors, monitor maternal labor pattern closely for hypertonicity or signs of weakening uterine muscle.
  • Recognize signs of impending rupture, immediately notify the physician, and call for assistance.

2. Assist with rapid intervention.

  • If the client has signs of possible uterine rupture, vaginal delivery is generally not attempted.
  • If symptoms are not severe, an emergency cesarean delivery may be attempted and the uterine tear repaired.
  • If symptoms are severe, emergency laparotomy is performed to attempt immediate delivery of the fetus and hen establish homeostasis.
  • Implement the following preparations for surgery.
    • Monitor maternal blood pressure, pulse, and respirations; also monitor fetal heart tones.
    • If the client has a central venous pressure catheter in place, monitor pressure to evaluate blood loss and effects of fluid and blood replacement.
    • Insert a urinary catheter for precise determinations of fluid balance.
    • Obtain blood to assess possible acidosis.
    • Administer oxygen, and maintain a patent airway.

3. Prevent and manage complications. Take these steps in order to prevent or limit hypovolemic shock:

  • Oxygenate by providing 8 to 10 L/min using a closed mask.
  • Restore circulating volume using one or more IV lines.
  • Evaluate the cause, response to therapy, and fetal condition.
  • Remedy the problem by preparing the client for surgery and administering antibiotics.

4. Provide physical and emotional support.

  • Provide support for the client’s partner and family members once surgery has begun.
  • Inform the partner and family how they will receive information about the mother and newborn and where to wait.

Exam

Welcome to your Uterine Rupture Practice Exam! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 5 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Focus on the intervention that addresses the immediate life-threatening complication of uterine rupture, which involves significant blood loss.

1 / 5

1. Nurse Green is caring for a patient when uterine rupture occurs. What should be the priority intervention?

💡 Hint

Consider the intervention that involves external force, which may increase the risk of trauma to the uterus during delivery.

2 / 5

2. Nurse Miller is assisting in the vaginal delivery of a newborn in the labor room. She knows to monitor the mother closely for the risk of uterine rupture if which of the following situations occurs?

💡 Hint

Consider the patient's history of a previous C-section and the sudden relief of pain followed by loss of consciousness, which may indicate a serious complication involving the integrity of the uterus.

3 / 5

3. Nurse Davis is caring for a patient in the labor and delivery suite at 36 weeks' gestation. The patient has a history of C-section and presents with severe abdominal pain that began less than an hour ago. Upon palpation, Nurse Davis notes tetanic contractions. After vomiting, the patient reports that the pain has improved and then loses consciousness. What is the most likely cause of her symptoms?

💡 Hint

Focus on the potential complication that involves excessive uterine activity, which can occur during labor induction.

4 / 5

4. Nurse Taylor is monitoring a patient during the induction of labor. Which sign should Nurse Taylor be particularly vigilant about?

💡 Hint

Think about the timing that maximizes the effectiveness of pushing during labor while ensuring safety for both the mother and the baby.

5 / 5

5. Nurse Simmons is coaching a laboring mother on when to start bearing down. At what stage of labor should the mother be advised to bear down?