Maternity - L&D, part 10: Uterine Rupture, Amniotic Fluid Embolism, Precipitous Labor
by Meris Shuwarger BSN, RN, CEN, TCRN November 19, 2021 Updated: August 09, 2023 6 min read
Hi. I'm Meris with Level Up RN. And in this video, I'm going to be talking to you about uterine rupture, amniotic fluid embolism, and precipitous delivery. I'm going to be following along using our maternity flashcards, which are available on our website, leveluprn.com. If you want a set for yourself, you can get them there. And if you already have a set, I would invite you to follow along with me. So let's go ahead and get started.
So first up, I'm talking about uterine rupture, which is what it sounds like. It is a rupture of the uterus, which is bad news bears. It's a really bad thing.
So this is going to be either incomplete or complete. Part of the broad ligament can be involved. The peritoneal cavity can be involved. But things are rupturing, and that is very scary and will require surgical repair.
So when we talk about risk factors, I want you to think back to some previous videos that I have made in this playlist.
We talked about something called uterine tachysystole or uterine hyperstimulation. So if that uterus is stimulated to the point where it's getting stronger and stronger and it's not relaxing, the contractions are happening too frequently, lasting too long, the contractions are too strong, the uterus isn't relaxing completely between contractions, that can-- just think about a rubber band, right? It's getting tighter and tighter and tighter. You're pulling it, pulling it, pulling it, and then it's going to pop, right? So that is a risk factor for uterine rupture.
Also, things would be overdistention of the uterus, like in a patient who has a multiple pregnancy or multigravid, so has had multiple pregnancies in the past, uterine trauma, so falling or being stabbed or something along those lines, and then previous uterine surgery.
So this is why, if you have a C-section, it is typically recommended to have a C-section again, is because-- depending on how long ago your section was, where the section was done, all kinds of different things.
If you had surgery before and then you go through labor, and again, we're going through those strong contractions, but now we have a weakness, we have scar tissue there, we're more likely to have uterine rupture. How are we going to know that our patient has experienced this?
They're going to most likely to report a sharp tearing feeling that happens abruptly. It's going to come on out of nowhere. All of a sudden, I have this sharp tearing sensation.
May also see non-reassuring fetal heart rate patterns. So maybe we see the heart rate plummets, or we're starting to have big changes in D cells or different things like that. If we see something where it doesn't look like an A-OK-tracing, that should be a big red flag to you.
And in terms of rupture, think, too, that this can lead to hemorrhage. I have just popped open my uterus. My uterus is full of blood supply, so now that is likely bleeding out as well.
So we could see signs of hypotensive shock, right? So we could have a low BP, high heart rate, high respiratory rate. All of those different things could be present.
Complications here, hemorrhage, death, fetal hypoxia, fetal death. It's bad, right? It's a really big deal.
So what do we do? The big thing is we need to prepare for a splash-and-dash immediate C-section, right? There is no time to wait. We are running to the OR. Mom is probably getting general anesthesia and getting that baby out, and then we need to repair the uterus.
So moving on to amniotic fluid embolism. AFE is what it's abbreviated.
So this is when amniotic fluid actually gets into the maternal circulation and it obstructs the pulmonary vessels. So think about a DVT, a pulmonary embolism caused from the blood clot in the legs breaking off and getting into that pulmonary circulation. It's the same idea, except we're talking about amniotic fluid.
So very similarly, you're going to have signs and symptoms that mimic that of a PE, right? We're going to have a respiratory distress. We're going to have circulatory collapse. We could have sudden chest pain, dyspnea. So all of a sudden, I have chest pain, shortness of breath. I may have a sense of impending doom, tachycardia. I could have hypotension, all of those things that we think of as being a big deal. Something is wrong with my patient. That can indicate amniotic fluid embolism.
And this is a true medical emergency. You need resources right now.
You need everyone in this room because we can have really major complications. And a big one is we can end up with DIC disseminated intravascular coagulation. Amniotic fluid has a high level of thromboplastin, so that can increase clotting once it gets into the maternal circulation. Big deal there. It's a really, really big deal.
So you, as a nurse, administer oxygen just like you would for a pulmonary embolism. We're giving IV fluids, blood products as ordered. And then you may have to assist with CPR and mechanical ventilation of this patient. This can become a very serious issue in a matter of moments, so you need to be able to recognize the signs.
Moving on, we're going to talk about precipitous labor. What is a precipitous labor? That's a very fancy term, and that just means labor that lasts less than three hours from the onset of contractions to the delivery of the fetus. That's a very short time to say, "I think I'm in labor," and then the baby is here, right? So why does this happen?
Well, there's some risk factors, hypertensive disorders, oxytocin. If we're giving oxytocin, we can give too much, kind of push things along too fast. Younger maternal age. So if we have someone who is maybe a teenager or in their early 20s, they are more at risk for a precipitous delivery. Preterm delivery, lower infant birth weight, and placental abruption are also all possible risk factors.
So the signs and symptoms are we have an abrupt onset of strong contractions, right? And we are dilating very fast. Baby's station is progressing very fast, right? You've probably seen videos of precipitous deliveries before, where a patient delivers in their own car or right outside of the birthing center or something like that. Those are very commonly precipitous deliveries. I found out I was in labor. I got in the car to go, and baby came before we could even get to the hospital.
So complications, we can end up with maternal lacerations, tissue trauma, uterine rupture. But a big one is postpartum hemorrhage. It sounds kind of counterintuitive, but postpartum hemorrhage can happen with precipitous delivery. And just think about how fast all of that happened and how the uterus may have not been fully prepared and gone through normal labor the way that you would expect. We can also end up with trauma to the baby from being delivered so quickly as well.
So nursing care, it's going to kind of be the same nursing care as everything you would do for anyone who has had a baby, sidelining position, IV fluids, oxygen as needed. If we are giving oxytocin, we would stop it, right, because ooh, things are going too fast, and then assisting with emergency delivery. But I would also add we need to then be assessing mom more frequently for signs of postpartum hemorrhage.
Okay. So that was actually the last video in our labor and delivery playlist. So there's more coming with newborn care and postpartum care. So I do hope you'll subscribe so that you can be the first to know when those drop. But I'm going to give you a quiz to test your knowledge of the key facts that I gave you in this video. So get your thinking caps on, and let's go through it.
Okay. So first up, I want you to name two risk factors for uterine rupture. I gave you a whole bunch of them, but think about just two. Think if you can think of any two risk factors for uterine rupture. Next up is going to be you have a patient who is in labor and they report sudden onset chest pain and dyspnea. What complication might this patient be experiencing? And lastly, what is the definition of precipitous delivery? What qualifies as a precipitous delivery?
Thanks so much, and happy studying.
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