NCLEX Review Guide: Rupture of the Uterus

Definition and Types

• Uterine rupture is a complete or incomplete separation of the uterine wall during pregnancy or labor, creating a life-threatening emergency for both mother and fetus.
• Complete rupture involves all layers of the uterine wall including the peritoneum, while incomplete rupture involves the myometrium but leaves the peritoneum intact.

High-Risk Factors

• Previous cesarean section or uterine surgery creates scar tissue weakness - most common cause of rupture.
• Excessive uterine distention from polyhydramnios, multiple gestation, or macrosomic fetus increases wall tension.
• Prolonged labor with strong contractions, especially with cephalopelvic disproportion.
• Inappropriate use of oxytocin or prostaglandins causing hyperstimulation.
• Grand multiparity (>5 previous births) weakens uterine muscle integrity.

Early Warning Signs

• Sudden, severe abdominal pain between contractions - classic early sign that differentiates from normal labor pain.
• Cessation of uterine contractions after previously strong labor pattern.
• Vaginal bleeding that may be minimal initially but can progress rapidly.
• Feeling of "something tearing" or "popping" reported by the patient.

Progressive Signs

• Maternal tachycardia and hypotension indicating hypovolemic shock.
• Loss of fetal station - fetus may be palpated in abdomen outside uterus.
• Abnormal fetal heart rate patterns including bradycardia, late decelerations, or absent FHR.
• Rigid, tender abdomen with loss of uterine contractions.

Immediate Interventions

1. Stop oxytocin immediately if infusing to prevent further uterine stimulation.
2. Position patient in left lateral position to improve placental perfusion.
3. Establish large-bore IV access (18-gauge or larger) for rapid fluid resuscitation.
4. Administer oxygen at 8-10 L/min via face mask to maximize fetal oxygenation.
5. Continuously monitor maternal vital signs and fetal heart rate.
6. Prepare for emergency cesarean section and notify surgical team immediately.

Ongoing Assessment

• Monitor for signs of hemorrhagic shock including decreased blood pressure, increased pulse, pallor, and decreased urine output.
• Assess fundal height and abdominal contour for changes indicating fetal displacement.
• Prepare for blood transfusion by obtaining type and crossmatch for multiple units.
• Document all findings and interventions for legal and continuity purposes.