PLANNED TEACHING PROGRAMME ON PREVENTION OF UTERINE RUPTURE

1. PLANNED TEACHING PROGRAMME ONPREVENTION OF UTERINE RUPTURE

2. GUIDED BY: SR.AILEEN MATHIAS PROFESSOR DEPT. OF OBG FATHER MULLER COLLEGE OF NURSING

3. PREPARED BY: LIMIYA THOMAS II YEAR M.SC. NURSING FATHER MULLER COLLEGE OF NURSING

5. ANATOMY • The uterus is a hollow pyriform muscular organ situated in the pelvis between the bladder in the front and rectum behind. • Its weight varies from 50- 80 gm. • It has the following parts: body or corpus, isthmus and cervix.

6. DEFINITION • Uterine rupture is the separation of the wall of the pregnant uterus

7. The incidence is high due to unbooked obstetrical emergencies, poor antenatal care and increased previous cesarean section.

8. There is a lack of awareness in the population about the need for antenatal care and supervised hospital delivery - especially in those women who have had previous cesarean section.

9. Most cases of ruptures are preventable with good antenatal and intrapartum care, proper identification of high risk cases.

10. TYPES • Complete rupture – when all the layers of the uterine walls are separated • Incomplete rupture – when the uterine muscle is separated but visceral peritoneum is intact

11. CAUSES • cesarean section • spontaneous rupture is common in multiparity • placenta percreta, increta

12. trauma such as blow to the abdomen, car accident, forceps delivery • uterine anomalies • cornual pregnancy

13. CLINICAL FEATURES

14. Sudden onset of tearing abdominal pain • Pain referred to chest • Cessation of uterine contractions • Vaginal bleeding • Absent fetal heart rate

15. Hypovolemic shock • Tenderness and pain between contractions • Maternal tachycardia, hypotension, syncope • Hematuria • Fetal heart rate abnormalities • Fetal parts palpable through abdominal wall, hanging loose cervix

16. COMPLICATIONS • Hemorrhage and sepsis

17. MANAGEMENT • Hysterectomy • In selected cases suture repair with uterine preservation is performed.

18. PREVENTION • Postnatal care after cesarean section • Interdelivery interval • Antenatal care in subsequent delivery • Early diagnosis and management of risk factor • Fetal size • Maternal obesity • Hospitalized delivery

19. Postnatal care after cesarean section • After removing the first dressing she can take a shower because warm, clean water on the incision is soothing.

20. Instruct signs and symptoms of infection such as redness, presence of discharge, and report any of these signs to the health care provider.

21. Care of back postnatally • When feeding mother should sit back in a chair well supported with baby raised up on pillows to prevent slouched forward position. lifting should be avoided.

22. Discharge advice • not to lift objects heavier than 10lb • do not walk upstairs more than once a day for first 2 weeks

23. drink at least 6 glasses of water daily • rest at least two times a day for 1 hour

24. color of lochia changes from locia rubra (red)1 to 4days, serosa (yellowish / pale brownish) 5-9 days, to alba (white )10-15 days

25. do not use tampons • do not use public pools, hot tub • accept help from the family and friends in house cleaning activities.

26. Exercise following cesarean section Foot and leg exercise

27. Transversus exercise

28. Pelvic tilting

30. Double leg lifts and sit ups should never be performed.

31. Report to doctor if: • redness or drainage at the incision site • lochia heavier than normal menstrual period and foul odor • heavy bleeding/ passage of clots • swollen red painful area in the leg

32. abdominal pain [other than suture line / after pain discomfort] • temperature greater than 100F

33. frequency or burning on micturition or hematuria • Follow up after 2 weeks or as per doctor’s advice

34. Interdeliveryinterval • Interdelivery interval of less than 18 months were 3 times more likely to have uterine rupture. • The rate of uterine rupture decreases between each interdelivery interval. • scar may require 24 months to reach its full strength.

35. contraceptive methods are preventive methods to help women avoid unwanted pregnancies. They include all permanent and temporary measures to prevent pregnancy resulting from coitus.

36. spacing methods • barrier methods- eg: condom [nirodh] • intra uterine devices eg; copper T • hormonal methods eg: oral pills • miscellaneous eg : abstinence, safe period, breast feeding

37. Terminal methods • male sterilization – vasectomy • female sterilization - tubectomy

38. Breast feeding • A woman who is exclusively breast feeding, the contraceptive protection is about 98% upto 6 months of postpartum. • In non lactating mothers, ovulation occur as early as 4 weeks and in lactating mothers, 10 weeks after delivery.

39. Antenatal care in subsequent pregnancies

40. Generally antenatal check up is done at interval of 4 weeks upto 28 weeks, at interval of 2 weeks upto 36 weeks, and thereafter till delivery • Generally antenatal check up is done at interval of 4 weeks upto 28 weeks, at interval of 2 weeks upto 36 weeks, and thereafter till delivery

41. Maternal obesity Maternal obesity is a risk factor for uterine rupture.

42. Woman should eat adequately so as to gain optimum weight gain of 10-12 kg. • excessive weight gain increases antepartum and intrapartum complications including fetal macrosomia

43. Fetal size The risk for uterine rupture is Less if baby weighs less than 4 kg

44. Hospitalized delivery • Home deliveries are discouraged • hospitalized deliveries are mandatory for providing diligent and active care to the mother and thus reducing the maternal mortality and morbidity.

45. Thank you