severe respiratory distress (restless, dyspneic, pulmonary edema) o C/O sudden chest pain o Tachycardia 30
o Shock o Bleeding from IV site o Can progress to respiratory or cardiac arrest Patient Care: o O2 o IV access o Side lying o Blood o Palliative (ventilator, CPR) o Monitor fetal status o Prep for C/S Care of the woman with a uterine rupture May be complete or incomplete o Lose baby, may lose mom Associated factors o Mismanage Pitocin o Weak C/S scar o CPD – disproportion, defect to birth canal o Uterine abnormalities, trauma, overdistention, or hyperstimulation (Pitocin) o Version (turning?) o Multigravida patients o Forceps birth Associated risks o Death of mom and baby o Hysterectomy S+S o Excruciating pain, sharp (different quality than labor – can tell the difference), ripping or tearing sensation, uterine tenderness o Fetal distress (brady, late decels, minimal variability. Lose HR, if don’t get out super fast – lose baby b/c bleeding) o Loss of FHR o Contractions stop (watch for it in epidural pt. They won’t feel) o Altered uterine shape/fetal body parts palpable o Sx of hypovolemic shock (b/c bleeding internally) Clinical therapy o Fluids (IV) and blood o Prep for C/S and/or hysterectomy **Partial rupture – baby can survive **Total rupture – baby dies, and mom in surgery for bleeding Intrauterine fetal death/fetal demise Important to deliver the baby within 2 weeks 31
o If delivering vaginally = hard and long b/c no help from the baby o Takes while for body to initiate labor Can result in DIC – baby will release clotting factors in moms blood stream Provide emotional support Other Problems Cephalopelvic disproportion (CPD) o Results in prolonged labor o Necrosis of maternal soft tissue form prolonged pressure o Extreme molding of fetal head o Traumatic delivery o Possible C/S Retained placenta o Longer than 30 minutes Lacerations: 1 st through 4 th degree (p 159 of ati book) Chapter 26: Birth Related Procedures Specific Procedures Version: deliberately altering fetal position o ECV (external cephalic version) – MOST common Attempted after 37w (don’t try to turn before b/c surfactant released at 36 weeks and may cause labor. Also has more room to flip self back before.) Adequate amniotic fluid Single gestation Unengaged fetus – not in pelvis yet Reactive NST **DO NOT DO IF: multiples, oligohydramninos, engaged fetus, or NR- NST, uterine scarring Procedure On birthing unit (b/c chance baby goes in distress, need to be prepared) NPO x8hrs prior to procedure – avoid vomit U/S to assess risks/eligibility Maternal V.S/continuous fetal monitoring IV (fluid and tocolytics to relax uterus) Terabutaline (asthmatics to open bronchi, PTL) or Mag sulfate (relaxes uterus to allow turning) Supine or slight trendelnburg Ensure RhoGam was given at 28 weeks if mom is Rh neg (if >15mL of fetal blood is detected in maternal circulation after
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