Signs of uterine rupture during labor? - Mothering Forums

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Old 06-12-2014, 06:54 PM - Thread Starter
 
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Signs of uterine rupture during labor?

Could anyone give some insight on this? I am in no way trying to be or sound insensitive to those who have suffered rupture during childbirth. I am only trying to prepare myself if something goes wrong during my vba3c. I haven't met my OB yet, my doula has suggested her and she is vbac supportive, so I am excited and terrified all at the same time. I would like to hear from others.
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Old 06-20-2014, 09:55 AM
 
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Pain.

Pain is definitely a sign of a uterine rupture. The UNmedicated mother will feel the pain out of the ordinary during labor and know something is wrong before the blood is seen, the blood pressure changes, or there are signs of fetal distress. You need a hospital staff that will listen to your concerns too. The problem IS that hospitals like to order epidurals and all manner of analgesics during labor, so the mother will not know if the pain is significant or even feel it.

PItocin and any drug that augments labor will increase blood pressure and any mother's chances of having a uterine rupture whether or not that mother has had surgery on her uterus.

The chances for ANY mother having a uterine rupture in labor is 1%. The chances for a VBAC mother having a uterine rupture during labor is 2%. And a woman can suffer a uterine rupture at any point during pregnancy OR labor because of some physical conditions, but that is rare.

So try to stay drug free.

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Old 06-20-2014, 03:56 PM
 
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Often the first sign is changes in the foetal heart rate. Other signs may include changes in pain, as Applejuice mentioned. Usually from intermittent, contraction pain to continuous severe pain.

Catastrophic rupture may cause changes in the appearance and/or feel of the abdomen. You may be able to see/feel foetal parts more distinctly.

Haemorrhage, which will manifest as increased vaginal bleeding, generally but may be hidden in the abdominal cavity to some degree.

And, obviously, signs of blood loss such as dizziness, increased heart rate, decreased BP (usually a late sign in healthy adults).
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Old 06-21-2014, 11:19 AM
 
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Originally Posted by applejuice View Post
The chances for ANY mother having a uterine rupture in labor is 1%. The chances for a VBAC mother having a uterine rupture during labor is 2%.
Have you got a source for that? I'm sure the figures I've read are 1 in 300 for VBAC and almost nonexistent for non-VBAC.
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Old 06-21-2014, 02:09 PM
 
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That number is given in every medical text I have read on VBACs. The bottom line is that a uterine rupture is a risk in every pregnancy and labor and this risk doubles with any surgical procedure done on the uterus.

Other increased risks of pregnancy/labor/delivery following any surgery done on the uterus are placenta accreta, percreta, increta, and previa.

http://stanmed.stanford.edu/2013fall/article4.html
http://www.ejog.org/article/S0301-21...421-1/abstract

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Old 06-21-2014, 02:21 PM
 
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The risk of rupture for a non-VBAC is far less than 1 in 100. Goodness.

Quote:
data about the spontaneous rupture of unscarred uteri in developed countries, the rate was 1 per 8,434 pregnancies (0.012%)
http://reference.medscape.com/article/275854-overview

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Old 06-21-2014, 07:24 PM
 
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The data actually shows us that the rates of uterine rupture are much lower than previously estimated, at about 0.2%

https://www.npeu.ox.ac.uk/ukoss/news...iously-thought

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Old 06-21-2014, 07:46 PM
 
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Thank you, Phatui5. I always knew that the actual numbers were lower, but the 1-2% is what doctors typically tell women.


Whenever a uterine rupture does happen, it is catastrophic for the mother and her family.
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Old 08-28-2014, 05:37 PM
 
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Originally Posted by applejuice View Post
Thank you, Phatui5. I always knew that the actual numbers were lower, but the 1-2% is what doctors typically tell women.


Whenever a uterine rupture does happen, it is catastrophic for the mother and her family.
Does that depend on the definition of catastrophic? I'm curious because that's what I thought & was heart broken by my first CS. Then I met a woman who not only had one during her second delivery (a VBAC), it wasn't caught right away. She was fine, her baby was fine, but she did, I think, end up with a hysterectomy. Previous to meeting her I thought a rupture automatically meant someone died or nearly did.

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Old 08-28-2014, 06:00 PM
 
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Years ago, I understood it was standard practice for doctors to reach inside a successful VBAC patient and manually examine the uterus for small "windows" or "breaks" in the uterus. Such a practice can introduce germs of all kinds in the uterus and cause problems. I do not know if it is still a standard practice after the delivery. AFAIK this is one immediate way to find a small rupture.

Excess postpartum pain or bleeding would be a sign of a uterine rupture, but determining if the pain or bleeding is excessive and is a rupture is not an easy assessment.

I do not know if your friend's situation would be in that 0.2%. I assume the policy of the hospital and its malpractice insurance would determine how the numbers are crunched and reported.

I hope your friend is OK. There are risks in everything. That is why experts need to be honest.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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Old 08-28-2014, 08:18 PM
 
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Not all uterine ruptures are catastrophic. In fact most aren't. I listed the most common signs in my previous post. It is certainly not common practice to perform a manual examination of the uterus after a VBAC anymore. In fact I have never seen or heard of it being done in 14 years as a midwife. If there are no obvious signs of rupture then any small dehiscence in the scar will most likely heal themselves during the postpartum period. All the pressure is off the uterus after birth and as it contracts back to non-pregnant size that will naturally help to bring the edges of the scar together. If the woman developed signs of peritonitis or persistent blood loss then an exploratory laparotomy would be indicated.


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Old 08-28-2014, 09:16 PM
 
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Yes, I have seen several moms where a 'window" (an asymptomatic, non-life threatening opening in the uterus- rupture seems like a strong word here but it is) is seen in their uterus when they come in for their scheduled repeat c/s without labor, and maybe 1 in a woman laboring for a long time leading to a c/s, without a previous c/s. And honestly, no catastrophic ruptures (like, no deaths or even bad outcomes)- but I was in a setting that used continuous monitoring and no induction, very rare/virtually never pitocin with VBACs. And teaching hospitals, with anesthesia and surgeons all in-house, all the time. Who knows about the VBACs- we would have never known about their windows. But since it's basically just the amniotic sac keeping baby inside the uterus, and its also luck (?) that the placenta and the window didn't happen in the same spot, under other circumstances (induction, longer labors, not monitored) maybe it would be different. So, no statistics to share, just anecdotes.
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Old 08-28-2014, 09:20 PM
 
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I recall seeing studies that epidurals didn't mask ruptures, IMO because while pain is a symptom, so are fetal heart rate changes and changes in contractions, and you are for sure monitored continuously when you have an epidural. I don't have the studies in front of me, though.
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