Uterine Rupture, Amniotic Fluid Embolism, and Precipitous Delivery

Uterine Rupture

• Definition: A rupture of the uterus, potentially involving the broad ligament or peritoneal cavity, requiring surgical repair.
• Types: Incomplete or complete.
• Risk Factors:
  • Uterine tachysystole or hyperstimulation.
  • Overdistension of the uterus (e.g., multiple pregnancy, multigravida).
  • Uterine trauma (e.g., falls, stabbing).
  • Previous uterine surgery (e.g., C-section).
• Signs and Symptoms:
  • Sharp, tearing sensation reported by the patient.
  • Non-reassuring fetal heart rate pattern.
  • Possible hemorrhage leading to hypotensive shock (low BP, high HR, high RR).
• Complications:
  • Hemorrhage, maternal or fetal death, fetal hypoxia.
• Management:
  • Immediate C-section ("splash and dash").
  • Surgical repair of the uterus.

Amniotic Fluid Embolism (AFE)

• Definition: Amniotic fluid enters maternal circulation, obstructing pulmonary vessels, similar to a pulmonary embolism.
• Symptoms:
  • Respiratory distress, circulatory collapse, sudden chest pain, dyspnea.
  • Sense of impending doom, tachycardia, hypotension.
• Complications:
  • Potential for Disseminated Intravascular Coagulation (DIC) due to high thromboplastin levels in amniotic fluid.
• Nursing Care:
  • Administer oxygen, IV fluids, blood products.
  • May require CPR and mechanical ventilation.

Precipitous Delivery

• Definition: Labor lasting less than 3 hours from the onset of contractions to delivery.
• Risk Factors:
  • Hypertensive disorders, excessive oxytocin.
  • Younger maternal age, preterm delivery, low infant birth weight, placental abruption.
• Symptoms:
  • Abrupt onset of strong contractions.
  • Rapid dilation and baby's station progress.
• Complications:
  • Maternal lacerations, tissue trauma, uterine rupture.
  • Postpartum hemorrhage, potential trauma to the baby.
• Nursing Care:
  • Side-lying position, IV fluids, oxygen if needed.
  • Discontinue oxytocin if administered.
  • Assist with emergency delivery and monitor for postpartum hemorrhage.

Quiz Questions

1. Name two risk factors for uterine rupture.
2. What complication might be indicated by sudden onset chest pain and dyspnea in a laboring patient?
3. Define precipitous delivery.