UTERINE RUPTURE

 UTERINE RUPTURE

A. OUTLINE 5 SIGNS AND SYMPTOMS OF UTERINE RUPTURE [10%]

B. DISCUSS 5 PREDISPOSING FACTORS TO UTERINE RUPTURE [25%]

C. DISCUSS THE IMMEDIATE MANAGEMENT OF THE WOMAN WITH UTERINE RUPTURE [50%]

D. EXPLAIN THE 5 PREVENTION MEASURES TO UTERINE RUPTURE [15%]

ANSWERS

A. SIGNS AND SYMPTOMS

1. Uterine contractions

In early stages,the contractions may become stronger and severe then suddenly drops

2. Abdominal pain and tenderness

This occurs when contractions goes at peak

3. Vaginal bleeding

Blood may come out through the vagina or into the peritoneal cavity

4. Chest pain

Occurs during inspiration due to irritation of blood below the diaphragm

5. Hypovolemic shock

Happens due to excessive loss of blood

Plus Mbasela

6. Foetal distress

Due to reduced or no blood flow to the fetus

B. PREDISPOSING FACTORS

1. Misuse of oxytocin drugs

Overdose of oxytocin during augmentation or induction of labor may predispose a woman to uterine rupture.

2. Grand multi parity

Women who have had more than 5 children are at higher risk due to replacement of smooth muscles by fibrous tissue.

3. Previous caesarean section

Women have history of caesarean section and who fall pregnant before 24 to 36 months lapse are at higher risk of uterine rupture.

4. Use of African syntocynon

Use of African syntocynon by pregnant women in belief that it will help them deliver fast may lead to hypertonic uterine action leading to uterine rupture.

5. Obstructed labour

Due to over thinning of the lower uterine segment.

Plus Mbasela

6. Trauma

Any serious trauma to the abdomen or uterus such as RTA, falls etc may lead to uterine rupture

C. IMMEDIATE MANAGEMENT

NOTE: That Uterine rupture is an obstetric emergency condition, therefore it must be managed without delay.

AIMS

To resuscitate the woman

To prevent hypovolemic shock

To offer psychology care

To prevent other complications such as fetal death

RESUSCITATION

Since the woman is in distress due to haemorrhage, I will resuscitate the woman with the following measures.

Cannulate the woman and give iv fluids such as ringers lactate PRN to correct electrolyte imbalance

Assess the woman using ABC TECHNIQUE

A. for Airways ( check for patency)- remove secretions if any

B. for Breathing- count Respirations and assess if the woman is breathing noting the rate, intensity and duration.

C. For Circulation- check using pulse oximeter

Give 100% Oxygen and keep monitoring.

Assess any signs of pallor, cyanosis,any improvements

Arrest the bleeding

When the woman is out of danger, I will do investigations

INVESTIGATIONS

History taking

Which will reveal predisposing factors such as previous caesarean section,trauma, having taken African syntocynon.

Physical examination

Will reveal signs and symptoms like tachycardia, hypotension, excessive bleeding, restlessness, maternal distress.

Ultrasound scan

Will reveal the degree of the rupture

Full blood count

Will reveal hb levels, elevated white blood cells if any infections

Grouping and cross match

Will aid in blood transfusion as it will reveal the blood group

Clotting time

Abdominal palpation

Will reveal a tender uterus

IMMEDIATE MANAGEMENT CONTINUES

Give iv fluids such as ringers lactate to replace the lost fluids

Assess the degree of rupture using ultrasound scan

Transfuse blood depending on the haemoglobin levels

Observations

.Temperature to rule out infections

. Pulse to rule out tachycardia

. Respirations to rule out any difficulties in breathing

. Blood pressure to rule out hypotension

Give oxygen to promote gaseous exchange and supply to the fetus

Monitor fetal heart rate quarter hourly if present

Call the medical officer to reveal the patient

The medical officer will decide the appropriate management for the woman probably laparotomy procedure

Medical officer to order for laparotomy

Give psychological care to Increase knowledge in her and prepare the woman for the operative procedure.

Get consent form signed for evidence that the woman has accepted the procedure to be done on her.

D. PREVENTION OF UTERINE RUPTURE

1. Give IEC

Give IEC to all women to avoid pregnancy after c/section until at least 24 to 36 months lapse.

2. Education

Educate women to avoid taking African syntocynon to prevent hypertonic uterine action.

3. Screening

Screening of all women that come for antenatal care for CPD and other risk factors

4. Management at the hospital

Advise all women with previous caesarean section to deliver at the hospital

5. Proper use of oxytocic drugs

Correct use of oxytocin will help prevent Uterine rupture.