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You are called to review a woman in labour ward. When you arrive you are told her epidural is no longer working. The epidural was placed by a colleague 5 hours ago and was working well. However in the last 20-30 minutes she has developed breakthrough pain despite a top up and pressing the PCEA a few times. You look at her back and the epidural dressing looks fine – no obvious explanation there.
Upon further questioning you are told that she had a caesarean in her previous pregnancy and she is attempting a VBAC. She tells you that since you arrived in the room the pain has changed. Now it is constant and she has developed pain in her shoulder. Suddenly the CTG deteriorates and within a few minutes the team are calling a code blue caesarean to theatre…..This is recollection of a real case from an evening shift a few years ago.
As you can probably guess this week we are discussing the important and somewhat scary topic of uterine rupture.
This week we are joined to discuss this topic by Dr David Owen. David is a senior obstetrician, who previous to WA worked at Liverpool Women’s Hospital and was a psychiatrist in a previous life.
Thanks David!
References
Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi, India
Tocogram characteristics of uterine rupture: a systematic review