Self-Assessment Questions (SAQs) for Study Session 10

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 10.1 (tests Learning Outcomes 10.1 and 10.2)

What are the main factors that may predispose a woman to develop a uterine rupture?

Answer

Factors predisposing a woman to develop a uterine rupture (key words in bold) are:

  • Obstructed labour caused by: the fetal head being too large or the mother’s pelvis being too small for the baby to descend through the birth canal (cephalopelvic disproportion); malpresentation and malposition of the fetus; or multiple pregnancy (see Study Session 8 for details of all these).
  • Other physical obstructions such as a tumour, or scarring from damage at a previous birth (e.g. a fistula, a torn opening between the vagina and bladder, rectum, urethra or ureter).
  • Traditional practices, e.g. inappropriate abdominal massage or pushing down on the fundus during labour.
  • Inappropriate use of a uterotonic drug (used to cause contractions).

SAQ 10.2 (tests Learning Outcomes 10.1 and 10.2)

Why are multiparous women at greater risk of uterine rupture than primiparous women?

Answer

Primiparous women are giving birth for the first time. In a first birth there is the likelihood of a longer labour. However, in primiparous women, uterine inertia (contractions become weaker and shorter, with longer intervals) occurs after about 36 hours, greatly reducing the risk of uterine rupture.

In contrast, in multiparous women have had at least one baby after 28 weeks’ gestation, the uterus will go on contracting strongly for much longer than the primiparous uterus. If obstruction prevents delivery for a long time, particularly if there is scarring from a complicated earlier birth, the uterus is much more likely to rupture.

SAQ 10.3 (tests Learning Outcome 10.3)

Complete Table 10.1 below by adding details of the warning signs of a possible uterine rupture.

Table 10.1  Warning signs of possible uterine rupture.

ActionsWarning signs
Timing the stages of labour

Timing the uterine contractions

Checking the fetal heart rate

Checking the abdomen

Answer

The completed version of Table 10.1 appears below.

Table 10.1  Warning signs of possible uterine rupture (completed).

ActionsWarning signs
Timing the stages of labourLabour is prolonged: latent first stage lasts more than 8 hours; active first stage lasts more than 12 hours; second stage lasts more than 1 hour in a multipara, or more than 2 hours in a primipara
Timing the uterine contractionsPersistent uterine contractions of 60-90 seconds duration or longer, occurring more than 5 times in every 10 minutes
Checking the fetal heart rateFetal heart rate persistently above 160 beats/minute or below 120 beats/minute
Checking the abdomenLower segment of the uterus is tender on palpation; Bandl’s ring is present
Checking the vaginaVaginal bleeding may be present

SAQ 10.4 (tests Learning Outcomes 10.3 and 10.4)

  • a.What complications may follow uterine rupture?
  • b.What actions should you take if uterine rupture occurs?

Answer

  • a.Complications of uterine rupture include:
    • Death of the fetus unless there is immediate surgery to remove it.
    • Severe haemorrhage and haemorrhagic shock for the mother (identified by faintness, pale skin, fast pulse, dropping blood pressure, fast breathing, lapses into unconsciousness, reduced urine output) leading to death of the mother unless she gets immediate treatment.
    • Infection: peritonitis (infection of the abdominal cavity) and/or septicaemia (bacterial infection of the blood), leading to potentially fatal septic shock.
    • Acute kidney failure (because of loss of blood volume).
    • Hysterectomy.
  • b.The most important action is to get the woman to the nearest health facility capable of dealing with a ruptured uterus as quickly as possible; she needs to be kept warm and calm, lying down with feet higher than ‘her’ head and her head on one side. You should give her intravenous fluids. If she is unconscious do not give anything by mouth.

Summary of Study Session 10