1. UTERINE RUPTURE

2. Definition
• A uterine rupture is a tear in the wall of the
uterus, most often at the site of a previous c-
section incision.
• Fortunately, these ruptures are relatively rare
events – exceedingly rare for women who've
never had a c-section, other uterine surgery, or
a previous rupture. The vast majority of
uterine ruptures occur during labor, but they
can also happen before the onset of labor.

3. CAUSES
• Cephalopelvic Disproportion- This is when the
mother’s pelvis is too small for the size of the
baby, resulting in the baby being unable to pass
through the birth canal.
• Grand multiparity. This is when the mother has
given birth 5 or more times.
• Uncontrolled use of Pitocin ( Oxytocin). This is
probably the leading cause of rupture of the
unscarred uterus. Oxytocin can cause
contractions to be too strong and too frequent,
which puts a lot of strain on the uterus .

4. • Placental Abruption. This is when the
placental lining separates from the uterus. This
can cause the baby to be either partially or
completely cut off from the mother’s
circulation.

5. • Malpresentation. This is when the baby is not in
the normal head-first position,include
brow, face and shoulder presentations.
• Operative deliveries. Using a delivery device,
such as forceps or performing internal version,
can cause uterine rupture.

6. Risk Factor
• Congenital uterine anomalies,
• multiparity,
• previous uterine myomectomy,
• the number and type of previous cesarean
deliveries,
• fetal macrosomia,
• labor induction,
• uterine instrumentation, and
• uterine trauma all increase the risk of uterine
rupture,

7. TYPES
• Incomplete rupture
• complete rupture

8. • In an Incomplete uterine rupture, the
mother’s peritoneum remains intact.
The peritoneum is the membrane that
lines the abdominal cavity to support
abdominal organs. It also acts as a
channel for blood vessels and nerves.
An incomplete uterine rupture is
significantly less dangerous with fewer
complications to the delivery process.

11. • During a Complete uterine rupture, the
peritoneum tears and the contents of the mother’s
uterus can spill into her peritoneal cavity. The
peritoneal cavity is the fluid-filled gap that
separates the abdomen walls and its organs. It is
suggested that delivery via cesarean section (C-
section) should occur within approximately 10 to
35 minutes after a complete uterine rupture
occurs. The fetal morbidity rate increases
dramatically after this period.

14. Types of scars that can cause a ruptured
uterus
• C-section scar
• Hysterotomy scar. Hysterotomy is in incision in the
uterus made during a C-section when the baby has
shoulder dystocia (shoulder caught on mother’s pelvis).
• Uterine perforation scar. This can occur as a result of
any complication involving the uterus and trans-cervical
procedures.
• Myomectomy or metroplasty scar. Scars from removal
of fibroids in the uterus.
• Scar from previous repair of a ruptured uterus

15. Signs and Symptoms
• Vaginal bleeding
• Sharp pain between contractions
• Contractions that slow down or become less intense
• Unusual abdominal pain or tenderness
• Recession of the fetal head (baby’s head moving back
up into the birth canal)
• Bulging under the pubic bone (baby’s head has
protruded outside of the uterine scar)
• Sharp onset of pain at the site of the previous scar
• Uterine atony (loss of uterine muscle tone)
• Maternal tachycardia (rapid heart rate) and hypotension

16. 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.

17. 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 then establish homeostasis.
• Implement the following preparations for surgery.

18. • 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.

19. 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.

20. 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.

21. TREATMENT
• Women’s general condition must be improved
giving blood transfusion, glucose solution)
• immediate laparotomy
( is used to explore the mother’s abdominal wall and a
C-section is performed.)
• Hysterectomy
(-is an operation to remove a woman's uterus. A woman
may have a hysterectomy for different reasons,
including:

22. THANKS FOR YOURATTENTION