UTERINE

PROLAPSE
What is uterine prolapsed?

• Uterine prolapse is falling or

sliding of the uterus from its
normal position in the pelvic
cavity into the vaginal canal
Causes:

• Multiparity
• When the muscles and connective tissues
weakens
• Normal aging and lack of estrogen
hormone after menopause
• Chronic constipation
• Pelvic tumor
Symptoms

• A feeling as if "sitting on a small ball"

• Difficult or painful sexual intercourse
• Low backache
• Protrusion from the vaginal opening
• Sensation of heaviness or pulling in the
pelvis
• Vaginal bleeding
Three (3) degrees of uterine prolapse:

• 1st degree- the cervix is visible at the vaginal

introitus, or opening without straining.
• 2nd degree- the cervix is extends beyond the
vaginal opening to the perineum
• 3rd degree- the uterus protrudes outside of the
vagina. This severe condition is called
procidentia uteri
Woman who are at risk:

• Woman with multiparity

• Inability to maintain the perineal
musculature
• Woman with chronic constipation
• Woman with lack of estrogen level after
menopause
 ADPIE
FOR UTERINE
PROLAPSE
Assessment:

• Physiologic changes
• Behavioral changes
• Patient’s past experiences with health
problems
• Patient’s and family’s perception of
patient’s health problem
• History of multiple pregnancies, prolonged
or difficult labor
• Age
• Vital signs
Diagnosis:
• Stress urinary incontinence related to
weak pelvic musculature
• Disturbed body image related to
biophysical changes

Planning:
• Patient will maintain continence
• Patient will state increase of comfort
• Patient will acknowledge change in body
image
• Patient will demonstrate ability to practice
new coping behavior
Intervention:

• Accept patients perception of self

• Make use of relaxation techniques to
promote comfort for the patient
• Encourage patient to participate
actively in performing care
• Provide appropriate care for patient’s
condition, monitor progress
• Promote patient’s wellness through
education
• Administer medications as prescribed
Intervention:

• Accept patients perception of self

• Make use of relaxation techniques to
promote comfort for the patient
• Encourage patient to participate
actively in performing care
• Provide appropriate care for patient’s
condition, monitor progress
• Promote patient’s wellness through
education
• Administer medications as prescribed
UTERINE RUPTURE
• The term “uterine rupture” is used from anything in a continuum of events,
from a weak spot in the uterine wall noticed by the surgeon at the time of
cesarean to the catastrophe of the uterus tearing open and the fetus,
placenta, and a lot of blood extruding into the mother’s abdomen.
A spontaneous or traumatic rupture of the uterus ie., the actual separation of
the uterine myometrium/ previous uterine scar, with rupture of membranes
and extrusion of the fetus or fetal parts into the peritoneal cavity. Dehiscence
is the partial separation of the old uterine scar; the fetus usually stays inside
the uterus and the bleeding is minimal when dehiscence occurs.
Who is at risk of uterine rupture?

• Woman who have previous surgery on the uterus

• Prior classical cesareans, where the incision is
near the top of the uterus
• Prior removal of fibroid tumors if the incision
extended through the full thickness of the uterine
wall
• Any other surgery that went through the full
depth of the muscular portion of the uterus
• Grand multiparity
• Fetal malpresentation
• Labor- inducing medications
• Multiple gestation
What are signs of uterine rupture?

• Localized pain and abnormalities of the fetal

heart rate

• There may be vaginal bleeding and the

vaginal examination ,may show that the baby
is not as low in the birth canal as he had been
earlier.
Rupture of the uterus during pregnancy or labor is a
serious emergency that can be fatal to both
mother and fetus. Uterine rupture results in:

• bleeding;
• rupture of the amniotic sac (bag of waters);
• partial or full delivery of the fetus into the
abdominal cavity; and
• loss of oxygen delivery to the fetus.

Classic symptoms of rupture include:

• pain above and beyond normal labor pain;

• discontinuation of uterine contractions;
• signs of fetal heart rate abnormalities;
• hemorrhage; and
• shock.
How to prevent uterine rupture?

• Sudden severe abdominal pain in later

pregnancy should be reported to your
physician,especially if you are at increased
risk for rupture of the uterus.

• Women with risk factors such as prior

classical cesarean, deep fibroid excisions,
and other major uterine surgeries should not
attempt labor, and should be scheduled for
cesarean as soon as the fetus is expected to
do well out in the wolrd, usually 36 and 39
weeks of gestation.
 ADPIE
FOR UTERINE RUPTURE
Assessment:

• Descriptive characteristic of pain, including location, quality,

intensity on a scale of 1-10, temporal factors and sources of relief
• Fluid and electrolyte status, including weight, intake and output,
urine specific gravity, skin turgor, and mucous membranes
• Physiologic factors such as age and pain tolerance.
• Physiological variables, such as body image, personality, previous
experience with pain, anxiety, and secondary gain.
• Pulse, blood pressure, respirations, and temperature
• Evaluate maternal vital signs; especially note an increase in rate
and depth of respirations, an increase in pulse , or a drop in BP
indicating status change.
• Observe for signs and symptoms of impending rupture (ie, lack of
cervical dilatation, tetanic uterine contractions, restlessness,
anxiety, severe abdominal pain, fetal bradycardia, or late or
variable decelerations of the FHR).
• Assess fetal status by continuous monitoring.
• Speak with family, and evaluate their understanding of the
situation.
Diagnosis:

• Deficient Fluid Volume related to active

fluid loss from hemorrhage
• Fear related to surgical outcome for fetus
and mother
• Acute pain related to biophysical factors

• Health seeking behaviors related to lack of

information about signs of delayed
postpartal hemorrhage
Planning:

• Patient will identify pain characteristics

• Patient will articulate factors that intensify
pain and will modify behavior accordingly
• Patient will express feeling of comfort and
relief of pain
• Patient’s vital signs will remain stable
• Skin color evaluation will remain normal
• Fluid volume will remain adequate
• Fluid and blood volume will return to
normal
Intervention:

• Assess patient’s signs and symptoms of pain and administer

pain medication as prescribed
• Start or maintain an IV fluid as prescribed. Use a large gauge
catheter when starting the IV for blood and large quantities of
fluid replacemnt.
• Perform comfort measures to promote relaxation such as
relaxation techniques
• Administer fluids, blood or blood products
• Give brief explanation to the woman and her support person
before beginning a procedure.
• Answer questions that the family or woman may have.
• Maintain a quiet and calm atmosphere to enhance relaxation.
• Remain with the woman until anesthesia has been
administered; offer support as needed.
• Keep the family members aware of the situation while the
woman is in surgery and allow time for them to express
feelings.
Evaluation:

• Patient is able to identify characteristics of

pain
• Patient is able to articulate factors that
intensify pain and modifies behavior
accordingly
• Patient is able to express feeling of comfort
and relief of pain
• Patient’s vital signs remains stable
• Skin color evaluation remains normal
• Fluid volume remains adequate
• Fluid and blood volume returns to normal
THANK
YOU!!!