ob 23 part 2_ uterine rupture to cord prolapse Flashcards
What is uterine rupture, and when does it most often occur?
A rare but possible labor complication, most common in patients with a previous cesarean scar.
What are contributing factors to uterine rupture?
Prolonged labor, abnormal presentation, multiple gestation, unwise use of oxytocin, obstructed labor, and traumatic maneuvers with forceps or traction.
What is the primary risk if uterine rupture occurs?
Fetal death unless immediate cesarean birth is performed.
What is the hallmark symptom of uterine rupture?
Sudden, severe pain during a strong labor contraction, described as a “tearing” sensation.
What are the signs of uterine hemorrhage following rupture?
Blood floods into the abdominal cavity and possibly the vagina.
What are the signs of hypotensive shock due to uterine rupture?
Rapid, weak pulse; falling blood pressure; cold and clammy skin; dilated nostrils from air starvation.
What happens to fetal heart sounds during uterine rupture?
They fade and then become absent.
What is uterine inversion?
The uterus turns inside out, occurring with the birth of the fetus or delivery of the placenta.
What are the causes of uterine inversion?
Traction on the umbilical cord to remove the placenta or excessive traction on the uterine fundus when the uterus is not contracted.
What are the signs of uterine inversion?
A sudden large gush of blood from the vagina, absent fundus in the abdomen, hypotension, dizziness, paleness, diaphoresis.
Why is uterine inversion dangerous?
The uterus cannot contract in this position, leading to continued bleeding and possible exsanguination within 10 minutes.
What is the first step in managing uterine inversion?
Stop oxytocin if it is being used.
What IV intervention is necessary for uterine inversion?
Insert a large-gauge IV needle for fluid and blood replacement.
What oxygen intervention is needed for uterine inversion?
Administer oxygen by mask and assess vital signs.
What emergency intervention should be prepared for in uterine inversion?
Prepare to perform CPR if heart failure occurs due to sudden blood loss.
What is an umbilical cord prolapse?
A medical emergency where the umbilical cord slips ahead of the fetus, leading to cord compression and decreased fetal oxygenation.
What is the primary goal in managing umbilical cord prolapse?
Relieve pressure on the cord and prevent fetal anoxia.
How is pressure on the umbilical cord relieved?
Place a gloved hand in the vagina and manually elevate the fetal head off the cord.
What positioning helps relieve umbilical cord compression?
Knee–chest or Trendelenburg position to allow the fetal head to fall back from the cord.
What oxygen intervention is needed for umbilical cord prolapse?
Administer oxygen at 10 L/min by face mask.
What medication may be used for umbilical cord prolapse?
A tocolytic agent to reduce uterine contractions.
What should be done if the umbilical cord is exposed to air?
Cover the cord with a sterile saline compress to prevent drying and constriction of vessels.
