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Sgayer I, Dabbah S, Farah RK, Wolf M, Ashkar N, Lowenstein L, Odeh M. Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature. Obstet Gynecol Surv 2023; 78:759-765. [PMID: 38134341 DOI: 10.1097/ogx.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes. Objective To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus. Evidence Acquisition PubMed was searched for the phrases "uterine rupture," "unscarred," and "spontaneous." Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included. Results We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries. Conclusions and relevance Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy.
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Affiliation(s)
- Inshirah Sgayer
- Head of Maternal and Fetal Clinic, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Clinical Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Shirin Dabbah
- Medical Student, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Rola Khamisy Farah
- Clalit Health Service, Akko, Senior Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Maya Wolf
- Head of Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Senior Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Nadine Ashkar
- Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Galilee Medical Center
| | - Lior Lowenstein
- Head of Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Associate Clinical Professor, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Marwan Odeh
- Associate Clinical Professor, Azrieli Faculty of Medicine, Bar Ilan University, Safed; Head of Obstetrical Ultrasound Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Hussein AI, Omar AA, Hassan HA, Kassim MM, Yusuf AA, Osman AA. Spontaneous Rupture of Unscarred Uterus in a Term Primagravida with Lethal Skeletal Dysplasia Fetus (Thanatophoric dysplasia). A Case Report and Review of the Literature. Int Med Case Rep J 2022; 15:551-556. [PMID: 36225974 PMCID: PMC9549793 DOI: 10.2147/imcrj.s383195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Importance Spontaneous uterine rupture, especially in an unscarred uterus, is a rare pregnancy complication that can cause severe morbidity and mortality in both the mother and the fetus. The vast majority of uterine ruptures occur in the presence of a previous uterine scar, most commonly from a previous cesarean delivery. To our knowledge, here we reported the first case of spontaneous rupture of unscarred uterus in a term primigravida secondary to lethal skeletal dysplasia fetus (Type 1 Thanatophoric dysplasia) faced by a practicing clinician in an underdeveloped country (Somalia) with a successful outcome. Case Presentation The patient was 24 yrs. Old Primagravida, at 40 weeks gestation by LMP, presented with abdominal pain and active vaginal bleeding; she did not receive antenatal care during pregnancy; after initial abdominal ultrasonography and vaginal examination, laparotomy was performed due to high suspicion of uterine rupture. After dead fresh fetal extraction, the uterine defect was repaired successfully, and the patient was discharged home in good condition after several days. Conclusion Through this case, we would like to highlight the urgent need to focus on and recognize the importance of receiving antenatal care in the community so that the burden of thousands of lives lost each year can be reduced.
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Affiliation(s)
- Ahmed Issak Hussein
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia,Correspondence: Ahmed Issak Hussein, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Tel +252615597479, Email
| | - Abdikarim Ali Omar
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Hodan Abdi Hassan
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Mukhtar Kassim
- Pediatric Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | | | - Ahmed Adam Osman
- Radiology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Luke ND, Risseeuw R, Mercado F. Concealed Uterine Rupture in the Broad Ligament in an Unscarred Uterus With Postpartum Hemorrhage. Cureus 2022; 14:e26041. [PMID: 35865436 PMCID: PMC9293276 DOI: 10.7759/cureus.26041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/05/2022] Open
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Choi LA, Chung AA, Pierce B. Late Presentation of Uterine Rupture Following Vaginal Birth After Cesarean Delivery: A Case Report. AJP Rep 2020; 10:e300-e303. [PMID: 33094018 PMCID: PMC7571556 DOI: 10.1055/s-0040-1715175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background A trial of labor after cesarean delivery is associated with uterine rupture rates of 0.5 to 0.9%, which can have devastating neonatal and maternal consequences. While uterine rupture typically occurs during labor, it can clinically manifest after delivery. Case A 23-year-old multiparous female presented in labor at term. Her obstetrical history was significant for a prior low transverse cesarean delivery. She had an uncomplicated labor course and spontaneous vaginal delivery. Immediately after delivery, she complained of severe right shoulder and left lower quadrant pain. Bedside ultrasound revealed a 10-cm, complex, adnexal mass adjacent to the uterus without free fluid. She was hemodynamically stable and appeared clinically well. On repeat ultrasound, the mass was unchanged; however, the patient now had free intraperitoneal fluid along the liver edge. Emergent laparotomy revealed a uterine rupture along her prior hysterotomy with extension into the right uterine artery. A 10-cm broad ligament hematoma ruptured posteriorly resulting in a 1-L hemoperitoneum. She received multiple blood products intraoperatively and recovered well postpartum. Conclusion Delivery after trial of labor after cesarean delivery usually decreases acuity; however, these patients remain at risk for significant complications. Clinicians should continue to assess patients in the immediate postpartum period and proceed with surgical intervention if necessary.
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Affiliation(s)
- Lindsey A Choi
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Tripler Army Medical Center, Honolulu, Hawaii
| | - Ariel A Chung
- Department of Family Medicine, Tripler Army Medical Center, Honolulu, Hawaii
| | - Brian Pierce
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Tripler Army Medical Center, Honolulu, Hawaii
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Fukuoka Y, Katou H, Shibata T, Tokuda H, Iizuka N, Nakago S. Treatment strategy for failed repair of uterine rupture: Cleansing an abscess via the cervical Canal. J Obstet Gynaecol Res 2020; 46:1207-1210. [PMID: 32410216 DOI: 10.1111/jog.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 11/29/2022]
Abstract
We present a new, conservative treatment strategy for the cases in which an initial repair surgery of uterine rupture failed. In a case presented here, the patient underwent a repair surgery for the uterine rupture that became apparent 4 days after the cesarean delivery, but a part of the wound did not heal and an abscess formed in the surrounding area. The patient had purulent discharge from vagina, which led us to try to insert a Nelaton tube from vagina via cervical canal and to cleanse the abscess cavity. This procedure was successful and the abscess disappeared 38 days later, allowing the healing of the ruptured wound. The patient could deliver a baby 2 years later. Even if the initial repair treatment fails, a possibility of preserving the uterus should be considered for next pregnancy. One of the concrete treatment strategies for this purpose was presented.
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Affiliation(s)
- Yasunori Fukuoka
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Hiroki Katou
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Takashi Shibata
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Hisato Tokuda
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Noriaki Iizuka
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Satoshi Nakago
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
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Tan WX, Lv XJ, Yang RQ, Zhao BZ, Chen JY, Wu S, Zhao YH, Cui MH. Spontaneous rupture of an unscarred uterus with an intact amniotic sac extrusion and fetal leg entrapment at 28 gestational weeks: a case report. Gland Surg 2020; 9:459-462. [PMID: 32420274 DOI: 10.21037/gs.2020.02.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The spontaneous rupture of an unscarred uterus at 28 gestational weeks is an extremely rare event, particularly when associated with an intact amniotic sac extrusion and fetal leg entrapment, which has not been previously reported. A 27-year-old primigravid woman was referred to our department, due to perpetual abdominal pain, at 28 weeks and 5 days of gestation. The patient, G3p0, had previously undergone two induced abortions. At the time of admission, abdominal ultrasonography suggested a defect in the left uterine horn. An emergency laparotomy was subsequently performed and revealed an intact amniotic sac extrusion and fetal leg entrapment. Considering the risk of placental abruption, and the possibility of a secondary rupture if the gestation was not terminated, an emergency Cesarean section was recommended. Uterine rupture may be suspected whenever a patient complains of durative abdominal pain at 28 weeks and 5 days of gestation, even in the absence of an intra-abdominal hemorrhage or vaginal bleeding.
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Affiliation(s)
- Wen-Xi Tan
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Xue-Jiao Lv
- Department of Respiratory, The Second Hospital of Jilin University, Changchun 130041, China
| | - Rui-Qi Yang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Ben-Zheng Zhao
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Jun-Yu Chen
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Shan Wu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Yan-Hui Zhao
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Man-Hua Cui
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130041, China
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Hirayama T, Hiraoka Y, Kitamura E, Miyazaki S, Horie K, Fukuda T, Hidema S, Koike M, Itakura A, Takeda S, Nishimori K. Oxytocin induced labor causes region and sex-specific transient oligodendrocyte cell death in neonatal mouse brain. J Obstet Gynaecol Res 2019; 46:66-78. [PMID: 31746074 DOI: 10.1111/jog.14149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022]
Abstract
AIM Previous reports showed associations between oxytocin induced labor and mental disorders in offspring. However, those reports are restricted in epidemiological analyses and its mechanism remains unclear. In this study, we hypothesized that induced labor directly causes brain damage in newborns and results in the development of mental disorders. Therefore we aimed to investigate this hypothesis with animal model. METHODS The animal model of induced labor was established by subcutaneous oxytocin administration to term-pregnant C57BL/6J mice. We investigated the neonatal brain damage with evaluating immediate early gene expression (c-Fos, c-Jun and JunB) by quantitative polymerase reaction and TdT-mediated dUTP nick end labeling staining. To investigate the injured brain cell types, we performed double-immunostaining with TdT-mediated dUTP nick end labeling staining and each brain component specific protein, such as Oligo2, NeuN, GFAP and Iba1. RESULTS Brain damage during induced labor led to cell death in specific brain regions, which are implicated in mental disorders, in only male offspring at P0. Furthermore, oligodendrocyte precursors were selectively vulnerable compared to the other cell types. This oligodendrocyte-specific impairment during the perinatal period led to an increased numbers of Olig2-positive cells at P5. Expression levels of oxytocin and Oxtr in the fetal brain were not affected by the oxytocin administered to mothers during induced labor. CONCLUSION Oligodendrocyte cell death in specific brain regions, which was unrelated to the oxytocin itself, was caused by induced labor in only male offspring. This may be an underlying mechanism explaining the human epidemiological data suggesting an association between induced labor and mental disorders.
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Affiliation(s)
- Takashi Hirayama
- Graduate School of Agricultural Science, Tohoku University, Sendai, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuichi Hiraoka
- Graduate School of Agricultural Science, Tohoku University, Sendai, Japan.,Laboratory for Molecular Neuroscience, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eri Kitamura
- Graduate School of Agricultural Science, Tohoku University, Sendai, Japan.,Department of Cell Biology and Neuroscience, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinji Miyazaki
- Graduate School of Agricultural Science, Tohoku University, Sendai, Japan
| | - Kengo Horie
- Graduate School of Agricultural Science, Tohoku University, Sendai, Japan
| | - Tomokazu Fukuda
- Laboratory of Cell Engineering and Molecular Genetics, Iwate University Faculty of Science and Engineering, Morioka, Japan
| | - Shizu Hidema
- Graduate School of Agricultural Science, Tohoku University, Sendai, Japan
| | - Masato Koike
- Department of Cell Biology and Neuroscience, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Uterine Rupture on MRI Presenting as Nonspecific Abdominal Pain in a Primigravid Patient with 28-Week Twins Resulting in Normal Neurodevelopmental Outcomes at Age Two. Case Rep Obstet Gynecol 2019; 2019:2890104. [PMID: 31380130 PMCID: PMC6662414 DOI: 10.1155/2019/2890104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background Uterine rupture is a rare occurrence that requires a high index of suspicion, particularly in a primigravid patient who presents prior to the onset of labor. Mortality rates are particularly high in primigravid patients. Case A 36-year-old gravida 1, para 0 patient with dichorionic diamniotic twins presented at 28-weeks of gestation with abdominal pain. The pain was initially intermittent and felt to be musculoskeletal in origin. Ultrasound imaging after 3 days of worsening abdominal pain revealed extrauterine fluid, prompting an urgent MRI. MRI diagnosed the uterine rupture with hemoperitoneum and herniation of both amniotic sacs outside of the uterus, including one twin's torso and extremities, prompting emergency cesarean section. The premature twins required 2-month hospitalizations and had no neurodevelopmental impairments at 2-year follow-up. Conclusion We present a unique case of rupture of an unscarred uterus in a primigravid patient prior to the onset of labor. Multiple gestation is a risk factor. This report adds to a handful of cases in which a history of endometriosis or extrauterine pelvic surgery was also present. The use of ultrasound and MRI to evaluate nonspecific abdominal pain led to the diagnosis and survival of both the mother and her premature twins.
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Mulot S, Thibon P, Rikelman S, Andre M, Dreyfus M, Benoist G. [Uterine rupture of the unscarred uterus: A report of 10 cases]. ACTA ACUST UNITED AC 2018; 46:692-695. [PMID: 30293949 DOI: 10.1016/j.gofs.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Uterine rupture in the healthy uterus is a rare obstetrical complication, not much suspected and with badly identified risk factors. Thus, there exists frequent delay for treatment and therefore fetal-maternal important morbidity and mortality. This article describes clinical signs and symptoms, management, and maternal and neonatal prognosis of uterine rupture. METHODS Descriptive retrospective study within 13 maternity hospitals, reporting 10 series of cases of uterine rupture on gravid healthy uterus during the third trimester of pregnancy. RESULT The incidence was 2.8/100,000 births. Surgical treatment was conservative in 9 out of 10 cases, the maternal prognosis was good with no maternal deaths and 6 out of 7 patients had at least one subsequent pregnancy. The fetal prognosis was more reserved, with 2 fetal or neonatal deaths and 1 with motor disability. 6/6 patients (100%) had at least one iterative Caesarean section during the following pregnancies with healthy fetuses. CONCLUSION In this series of 10 cases over 25years, maternal-fetal morbidity and mortality were significant, in agreement with the literature. Maternal prognosis remained favorable. When surgical treatment is conservative a subsequent pregnancy is possible and an iterative cesarean section must be performed.
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Affiliation(s)
- S Mulot
- Gynécologie obstétrique, Caen University Hospital, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie 2, rue des Rochambelles, 14000 Caen, France.
| | - P Thibon
- Réseau périnatalité, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - S Rikelman
- Gynécologie obstétrique, Caen University Hospital, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie 2, rue des Rochambelles, 14000 Caen, France
| | - M Andre
- Centre hospitalier Flers, rue Eugène-Garnier, 61100 Flers, France
| | - M Dreyfus
- Gynécologie obstétrique, Caen University Hospital, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie 2, rue des Rochambelles, 14000 Caen, France
| | - G Benoist
- Gynécologie obstétrique, Caen University Hospital, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie 2, rue des Rochambelles, 14000 Caen, France
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Posthumus L, Donker ME. Uterine rupture in a primigravid patient, an uncommon but severe obstetrical event: a case report. J Med Case Rep 2017; 11:339. [PMID: 29208037 PMCID: PMC5718063 DOI: 10.1186/s13256-017-1507-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A spontaneous rupture of the unscarred uterus in a primigravid patient is extremely rare and is associated with high perinatal and maternal morbidity and mortality. CASE PRESENTATION A 34-year-old white primigravid woman, 31 + 3 weeks of gestation, presented with pre-eclampsia and developed a sudden acute abdomen. An emergency laparotomy was performed and a uterine rupture was found as the cause of the event. A stillborn girl was born. CONCLUSION A rupture of the pregnant uterus should always be considered in a pregnant woman presenting with abdominal pain, even in a primigravid patient.
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Affiliation(s)
- Lotte Posthumus
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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Rousseau A, Burguet A. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 5: Maternal risk and adverse effects of using oxytocin augmentation during spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:509-521. [PMID: 28473291 DOI: 10.1016/j.jogoh.2017.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- A Rousseau
- Département de Maïeutique, UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France; EA 7285 RISCQ, UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France.
| | - A Burguet
- Pédiatrie 2, CHU de Dijon, 21030 Dijon cedex, France; Réseau Périnatal Franche-Comté, CHU de Besançon, 25030 Besançon cedex, France
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Al-Zirqi I, Daltveit AK, Forsén L, Stray-Pedersen B, Vangen S. Risk factors for complete uterine rupture. Am J Obstet Gynecol 2017; 216:165.e1-165.e8. [PMID: 27780708 DOI: 10.1016/j.ajog.2016.10.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complete uterine rupture is a rare peripartum complication associated with a catastrophic outcome. Because of its rarity, knowledge about its risk factors is not very accurate. Most previous studies were small and over a limited time interval. Moreover, international diagnostic coding was used in most studies. These codes are not able to differentiate between the catastrophic complete type and less catastrophic partial type. Complete uterine rupture is expected to increase as the rate of cesarean delivery increases. Thus, we need more accurate knowledge about the risk factors for this complication. OBJECTIVE The objective of the study was to estimate the incidence and risk factors for complete uterine rupture during childbirth in Norway. STUDY DESIGN This population-based study included women that gave birth after starting labor in 1967-2008. Data were from the Medical Birth Registry of Norway and Patient Administration System, complemented with information from medical records. We included 1,317,967 women without previous cesarean delivery and 57,859 with previous cesarean delivery. The outcome was complete uterine rupture (tearing of all uterine wall layers, including serosa and membranes). Risk factors were parameters related to demographics, pregnancy, and labor. Odds ratios for complete uterine rupture were computed with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate the adjusted odds ratios and 95% confidence intervals. RESULTS Complete uterine rupture occurred in 51 cases without previous cesarean delivery (0.38 per 10,000) and 122 with previous cesarean delivery (21.1 per 10,000). The strongest risk factor was sequential labor induction with prostaglandins and oxytocin, compared with spontaneous labor, in those without previous cesarean delivery (adjusted odds ratio, 48.0, 95% confidence interval, 20.5-112.3) and those with previous cesarean delivery (adjusted odds ratio, 16.1, 95% confidence interval, 8.6-29.9). Other significant risk factors for those without and with previous cesarean delivery, respectively, included labor augmentation with oxytocin (adjusted odds ratio, 22.5, 95% confidence interval, 10.9-41.2; adjusted odds ratio, 4.4, 95% confidence interval, 2.9-6.6), antepartum fetal death (adjusted odds ratio, 15.0, 95% confidence interval, 6.2-36.6; adjusted odds ratio, 4.0, 95% confidence interval, 1.1-14.2), and previous first-trimester miscarriages (adjusted odds ratio, 9.6, 95% confidence interval, 5.7-17.4; adjusted odds ratio, 5.00, 95% confidence interval, 3.4-7.3). After a previous cesarean delivery, the risk of rupture was increased by an interdelivery interval <16 months (adjusted odds ratio, 2.3; 95% confidence interval, 1.1-5.4) and a previous cesarean delivery with severe postpartum hemorrhage (adjusted odds ratio, 5.6; 95% confidence interval, 2.4-13.2). CONCLUSION Sequential labor induction with prostaglandins and oxytocin and augmentation of labor with oxytocin are important risk factors for complete uterine rupture in intact and scarred uteri.
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13
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Spontaneous rupture and massive hemoperitoneum from uterine leiomyomas and adenomyosis in a nongravid and unscarred uterus. Taiwan J Obstet Gynecol 2016; 54:198-200. [PMID: 25951730 DOI: 10.1016/j.tjog.2014.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/20/2022] Open
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Abdalla N, Reinholz-Jaskolska M, Bachanek M, Cendrowski K, Stanczak R, Sawicki W. Hemoperitoneum in a patient with spontaneous rupture of the posterior wall of an unscarred uterus in the second trimester of pregnancy. BMC Res Notes 2015; 8:603. [PMID: 26498591 PMCID: PMC4620015 DOI: 10.1186/s13104-015-1575-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemoperitoneum resulting from a rupture of an unscarred uterus is a rare condition. Uterine rupture in patients without evident risk factors is associated with non-specific signs and symptoms that can delay the diagnosis. This is a report of spontaneous rupture of posterior wall of the uterus in the second trimester of pregnancy presented as intra-abdominal bleeding. CASE PRESENTATION Here, we report the case of a 31-year-old Caucasian multiparous female (gravida 3, para 1) who had a sudden onset of abdominal pain at 28 weeks of gestation. The patient had no history of caesarean section. Exploratory laparotomy was performed due to deterioration of the patient's clinical condition, and ultrasound results were suspicious for hemoperitoneum. Uterine rupture in the posterior wall with active bleeding from the defect was confirmed. A caesarean section was performed, and a live female infant weighing 1000 g, with an Apgar score of three, was delivered. A hysterectomy was performed during the caesarean section. CONCLUSION Diagnostic difficulties arise from the rarity of the disease, a nonspecific clinical picture and the absence of the main risk factors. Uterine rupture should be considered in the differential diagnosis of hemoperitoneum in patients with an unscarred uterus.
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Affiliation(s)
- Nabil Abdalla
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Kondratowicza Street 8, 03-242, Warsaw, Poland.
| | - Malgorzata Reinholz-Jaskolska
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Kondratowicza Street 8, 03-242, Warsaw, Poland.
| | - Michal Bachanek
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Kondratowicza Street 8, 03-242, Warsaw, Poland.
| | - Krzysztof Cendrowski
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Kondratowicza Street 8, 03-242, Warsaw, Poland.
| | - Ryszard Stanczak
- Department of Obstetrics and Gynecology, District Hospital in Wolomin, Wolomin, Poland.
| | - Wlodzimierz Sawicki
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Kondratowicza Street 8, 03-242, Warsaw, Poland.
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Acute uterine rupture in spontaneous term labour in a healthy primigravida: case report and review of the literature. CASE REPORTS IN PERINATAL MEDICINE 2015. [DOI: 10.1515/crpm-2015-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Uterine rupture is an obstetric complication with potential catastrophic fetal and maternal consequences, if not detected early and managed promptly. We report a case of a 32-year-old primigravida in spontaneous labour at term who had unprovoked acute uterine rupture. Operative findings at emergency caesarean section were a live female infant weighing 3150 g requiring resuscitation, massive haemoperitoneum, and large right vertical posterolateral uterine rupture at the upper segment, extending to the ovarian pedicle and down to the vagina vault.
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Gibbins KJ, Weber T, Holmgren CM, Porter TF, Varner MW, Manuck TA. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol 2015; 213:382.e1-6. [PMID: 26026917 DOI: 10.1016/j.ajog.2015.05.048] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/10/2015] [Accepted: 05/26/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We sought to report obstetric and neonatal characteristics and outcomes following primary uterine rupture in a large contemporary obstetric cohort and to compare outcomes between those with primary uterine rupture vs those with uterine rupture of a scarred uterus. STUDY DESIGN This was a retrospective case-control study. Cases were defined as women with uterine rupture of an unscarred uterus. Controls were women with uterine rupture of a scarred uterus. Demographics, labor characteristics, and obstetric, maternal, and neonatal outcomes were compared. Primary rupture case outcomes were also compared by mode of delivery. RESULTS There were 126 controls and 20 primary uterine rupture cases. Primary uterine rupture cases had more previous live births than controls (3.6 vs 1.9; P < .001). Cases were more likely to have received oxytocin augmentation (80% vs 37%; P < .001). Vaginal delivery was more common among cases (45% vs 9%; P < .001). Composite maternal morbidity was higher among primary uterine rupture mothers (65% vs 20%; P < .001). Cases had a higher mean estimated blood loss (2644 vs 981 mL; P < .001) and higher rate of blood transfusion (68% vs 17%; P < .001). Women with primary uterine rupture were more likely to undergo hysterectomy (35% vs 2.4%; P < .001). Rates of major composite adverse neonatal neurologic outcomes including intraventricular hemorrhage, periventricular leukomalacia, seizures, and death were higher in cases (40% vs 12%; P = .001). Primary uterine rupture cases delivering vaginally were more likely to ultimately undergo hysterectomy than those delivering by cesarean (63% vs 9%; P = .017). CONCLUSION Although rare, primary uterine rupture is particularly morbid. Clinicians must remain vigilant, particularly in the setting of heavy vaginal bleeding and severe pain.
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Affiliation(s)
- Karen J Gibbins
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT.
| | - Tiffany Weber
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Calla M Holmgren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - T Flint Porter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Michael W Varner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
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17
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Management of Persistent Postpartum Hemorrhage Caused by Inner Myometrial Lacerations. Obstet Gynecol 2015; 126:266-269. [DOI: 10.1097/aog.0000000000000757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Saciragic L, Mehdizadeh S, Amankwah Y, Singh S. Spontaneous Uterine Rupture of an Unscarred Uterus in a Twin Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:391. [PMID: 26168097 DOI: 10.1016/s1701-2163(15)30249-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lana Saciragic
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON
| | | | - Yaa Amankwah
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON; Faculty of Medicine, University of Ottawa, Ottawa ON
| | - Sukhbir Singh
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON; Faculty of Medicine, University of Ottawa, Ottawa ON
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19
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Rupture utérine spontanée d’un utérus exempt de cicatrice dans le cadre d’une grossesse gémellaire. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015. [DOI: 10.1016/s1701-2163(15)30250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, Subtil D. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol 2014; 179:130-4. [PMID: 24965993 DOI: 10.1016/j.ejogrb.2014.05.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Uterine rupture is a rare but potentially catastrophic complication of pregnancy that requires rapid diagnosis. Classically, its signs and symptoms combine pain, fetal heart rate (FHR) abnormalities, and vaginal bleeding. The purpose of this study is to identify these signs and symptoms as well as the immediate complications of complete and incomplete (partial) ruptures of the uterine wall, whether or not they follow a previous cesarean delivery. STUDY DESIGN Retrospective study of case records from two university hospital maternity units, from 1987 to 2008. RESULTS In a total of 97,028 births during the study period, we identified 52 uterine ruptures (0.05%): 25 complete and 27 partial. Most (89%) occurred in women with a previous cesarean delivery. In complete ruptures, FHR abnormalities were the most frequent sign (82%), while the complete triad of FHR abnormalities-pain-vaginal bleeding was present in only 9%. The signs and symptoms of partial ruptures were very different; these were asymptomatic in half the cases (48%). Neonatal mortality reached 13.6% among the complete ruptures; 27 and 40% of these newborns had pH<6.80 and pH<7.0, respectively. Among the incomplete ruptures, only 7.7% of the newborns had a pH<7.0 and there were no deaths. CONCLUSION Although complete rupture of the uterus has a severe neonatal prognosis, the complete set of standard symptoms is present in less than 10% of cases. FHR abnormalities are by far the most frequent sign.
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Affiliation(s)
- M Guiliano
- Pôle Femme Mère Nouveau-né et Pôle d'Anesthésie-Réanimation, Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, Lille Cedex 59037, France.
| | - E Closset
- Pôle Femme Mère Nouveau-né et Pôle d'Anesthésie-Réanimation, Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, Lille Cedex 59037, France
| | - D Therby
- Pavillon Paul Gellé, Centre Hospitalier de Roubaix, 91 avenue J Lagache, Roubaix 59100, France
| | - F LeGoueff
- Pavillon Paul Gellé, Centre Hospitalier de Roubaix, 91 avenue J Lagache, Roubaix 59100, France
| | - P Deruelle
- Pôle Femme Mère Nouveau-né et Pôle d'Anesthésie-Réanimation, Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, Lille Cedex 59037, France; EA 4489, Faculté de Médecine Henri Warembourg, Université Lille 2, UPRES Lille Nord de France, Lille, France
| | - D Subtil
- Pôle Femme Mère Nouveau-né et Pôle d'Anesthésie-Réanimation, Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, Lille Cedex 59037, France; EA2694, UDSL, Université Lille Nord de France, UHC Lille, Lille F-59000, France
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21
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Hooda R, Gupta A, Duhan N, Sirohiwal D, More H. Unexplained Spontaneous Complete Uterine Rupture in the Second Trimester: A Rare Event. Case Report and Literature Review. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2012.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Reetu Hooda
- Department of Obstetrics and Gynecology, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Anjali Gupta
- Department of Obstetrics and Gynecology, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Nirmala Duhan
- Department of Obstetrics and Gynecology, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Daya Sirohiwal
- Department of Obstetrics and Gynecology, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Hemant More
- Department of Accident and Emergency, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
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22
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Abstract
BACKGROUND Uterine rupture of an unscarred uterus is a rare complication in a quadruplet pregnancy. CASE A 30-year-old woman, gravida 4 para 0030, with a quadruplet pregnancy and no previous uterine surgeries presented with moderate vaginal bleeding at 32 4/7 weeks of gestation. Fetal testing was reassuring, and the cervix showed no signs of preterm labor. A decision was made to proceed with cesarean delivery because of the amount of vaginal bleeding, with surgical findings of uterine rupture superior to the lower uterine segment. CONCLUSION High-order gestations may be an independent risk factor for uterine rupture.
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23
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Nikolaou M, Kourea HP, Antonopoulos K, Geronatsiou K, Adonakis G, Decavalas G. Spontaneous uterine rupture in a primigravid woman in the early third trimester attributed to adenomyosis: A case report and review of the literature. J Obstet Gynaecol Res 2012; 39:727-32. [DOI: 10.1111/j.1447-0756.2012.02042.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 07/28/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Marinos Nikolaou
- Department of Obstetrics and GynecologyMedical SchoolUniversity of Patras Patras Greece
| | - Helen P. Kourea
- Department of PathologyMedical SchoolUniversity of Patras Patras Greece
| | - Kostas Antonopoulos
- Department of Obstetrics and GynecologyMedical SchoolUniversity of Patras Patras Greece
| | | | - George Adonakis
- Department of Obstetrics and GynecologyMedical SchoolUniversity of Patras Patras Greece
| | - George Decavalas
- Department of Obstetrics and GynecologyMedical SchoolUniversity of Patras Patras Greece
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24
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Bastos LF, van Meurs W, Ayres-de-Campos D. A model for educational simulation of the evolution of uterine contractions during labor. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 107:242-247. [PMID: 22047937 DOI: 10.1016/j.cmpb.2011.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 09/28/2011] [Accepted: 09/30/2011] [Indexed: 05/31/2023]
Abstract
Electronic fetal monitoring remains an important tool in labor ward settings, providing continuous information on fetal heart rate and maternal uterine contractions. A prompt detection of abnormalities in these signals is essential for the timely resolution of situations that may put both mother and fetus at risk. Uterine contraction signals provide information that is important to evaluate the onset and progress of labor, as well as the significance of certain fetal heart rate abnormalities. We present a model for educational simulation of the spontaneous evolution of uterine contractions during labor, which combines a previously published signal generator with literature-based pre-programmed scripts for educationally relevant scenarios. This model is an essential component of a high-fidelity simulator of intrapartum emergencies, aimed to improve the competency of healthcare providers. Real and simulated tracings were presented to three independent clinical experts who judged simulated signals to be indistinguishable or negligibly different from real tracings.
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25
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Sun HD, Su WH, Chang WH, Wen L, Huang BS, Wang PH. Rupture of a pregnant unscarred uterus in an early secondary trimester: a case report and brief review. J Obstet Gynaecol Res 2012; 38:442-5. [PMID: 22229814 DOI: 10.1111/j.1447-0756.2011.01723.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rupture of a pregnant uterus in early pregnancy and an unscarred uterus are extremely rare, and some non-specific symptoms might appear before this occurrence. We report the case of a multiparous woman (gravida 3, para 2) with uterine fundal rupture in her early second trimester (17+ weeks of gestational age), who presented upper abdominal discomfort and vomiting for 3 days, and progressed into sudden acute abdomen and shock. During emergent laparotomy, the entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Although we could not confirm that the appearance of upper gastrointestinal symptoms and severe vomiting was associated with uterine rupture in this pregnant woman, abdominal symptoms or signs might be a hint or cause of severe catastrophic pregnancy-related complications.
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Affiliation(s)
- Hsu-Dong Sun
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Ban Ciao, New Taipei City, Taiwan
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26
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Jo YS, Kim MJ, Lee GSR, Kim SJ. A large amniocele with protruded umbilical cord diagnosed by 3D ultrasound. Int J Med Sci 2012; 9:387-90. [PMID: 22811613 PMCID: PMC3399219 DOI: 10.7150/ijms.3383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 07/09/2012] [Indexed: 11/05/2022] Open
Abstract
An amniocele is a herniation of the amniotic sac through a uterine defect. Uterine rupture during pregnancy may develop as a result of a pre-existing injury, uterine anomaly, or unscarred uterus. A 30-year-old patient, with a history of 2 vaginal deliveries, presented an amniocele complicated by left fundal perforation and was evaluated with 3-dimensional ultrasound at 23 weeks. Because of worsening lower abdominal pain and vaginal bleeding, she underwent exploratory laparotomy. Herein, we report a uterine rupture with amniocele.
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Affiliation(s)
- Yun Sung Jo
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
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27
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Ijaz S, Mahendru A, Sanderson D. Spontaneous uterine rupture during the 1st trimester: A rare but life-threatening emergency. J OBSTET GYNAECOL 2011; 31:772. [DOI: 10.3109/01443615.2011.606932] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Yazawa H, Endo S, Hayashi S, Suzuki S, Ito A, Fujimori K. Spontaneous uterine rupture in the 33rd week of IVF pregnancy after laparoscopically assisted enucleation of uterine adenomatoid tumor. J Obstet Gynaecol Res 2011; 37:452-7. [DOI: 10.1111/j.1447-0756.2010.01361.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Chibber R, El-Saleh E, Fadhli RA, Jassar WA, Harmi JA. Uterine rupture and subsequent pregnancy outcome – how safe is it? A 25-year study. J Matern Fetal Neonatal Med 2010; 23:421-4. [DOI: 10.3109/14767050903440489] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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30
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Esike COU, Umeora OUJ, Eze JN, Igberase GO. Ruptured uterus: the unabating obstetric catastrophe in South eastern Nigeria. Arch Gynecol Obstet 2010; 283:993-7. [DOI: 10.1007/s00404-010-1488-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
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31
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Kurdoglu M, Kolusari A, Yildizhan R, Adali E, Sahin HG. Delayed diagnosis of an atypical rupture of an unscarred uterus due to assisted fundal pressure: a case report. CASES JOURNAL 2009; 2:7966. [PMID: 19830029 PMCID: PMC2740166 DOI: 10.1186/1757-1626-2-7966] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 03/23/2009] [Indexed: 11/29/2022]
Abstract
Introduction Although rare, rupture of an unscarred uterus is one of the most dangerous obstetric complications, resulting in maternal and fetal jeopardy. Case presentation A 30-year-old grand multiparous Turkish woman without any history of uterine surgery gave birth vaginally at 37 weeks of gestation with fundal pressure applied in the second stage of labor. Transabdominal sonography performed 32 hours after delivery due to postural hypotension and a drop in hemoglobin values in the postpartum period revealed massive intra-abdominal free fluid. On emergency laparotomy, serosal rupture of the uterus on the left posterior side was observed. She underwent a subtotal hysterectomy and did well postoperatively. Conclusion Postural hypotension in postpartum patients without any evident vaginal bleeding may be an early sign of possible uterine rupture, even if the vital signs are stable. Early diagnosis is important if maternal morbidity and mortality are to be decreased.
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Affiliation(s)
- Mertihan Kurdoglu
- Department of Obstetrics and Gynecology, Yuzuncu Yil University School of Medicine Van Turkey.
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32
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Sliutz G, Sanani R, Spängler-Wierrani B, Wierrani F. First trimester uterine rupture and scar pregnancy. Med Hypotheses 2009; 73:326-7. [PMID: 19356857 DOI: 10.1016/j.mehy.2009.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 02/27/2009] [Accepted: 02/28/2009] [Indexed: 11/18/2022]
Abstract
Uterine rupture during the first trimester of pregnancy is an extremely rare, but life-threatening cause of intraperitoneal hemorrhage. Up to the knowledge of the authors all reports of first trimester uterine ruptures are related to scar dehiscences following previous cesarean sections or occurred in unscarred uteri of multiparous women. In cases of multiparity silent ruptures cannot be precluded, so that the uterus might be scarred during the following pregnancy. In early pregnancy of approximately 4-5 weeks, vaginal ultrasonography may clearly verify a scar pregnancy, but sonographical diagnostic findings may change with the pregnancy progress. In all cases of reported first trimester ruptures in pregnancies with previous cesarean sections or in pregnancies of multiparous women reported in literature, dating scans were performed too late for to preclude pregnancies in the scar. We postulate our hypotheses, that all first trimester uterine ruptures are caused by scar implantation of the trophoblast.
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Affiliation(s)
- Gerhard Sliutz
- Rudolfstiftung Hospital, Dept. Gynecol./Obstet., Juchgasse 25, 1030 Vienna, Austria
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33
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Leung F, Courtois L, Aouar Z, Bourtembourg A, Eckman A, Terzibachian JJ, Maillet R, Riethmuller D. [Spontaneous rupture of the unscarred uterus during labor. Case report]. ACTA ACUST UNITED AC 2009; 37:342-5. [PMID: 19318288 DOI: 10.1016/j.gyobfe.2009.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/07/2009] [Indexed: 11/30/2022]
Abstract
We report a case of spontaneous uterine rupture in a 19 year-old patient Gravida 1 para 2 with no past history of uterine surgery. The diagnosis of uterine rupture, evoked in the early post-partum in the presence of acute abdominal pain, collapsus and haemoperitoneum on ultrasonography, was confirmed by laparotomy. Treatment consisted in hysterorrhaphy. The etiopathogenesis, clinical and therapeutical aspects of spontaneous unscarred uterine ruptures are discussed throughout a literature review.
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Affiliation(s)
- F Leung
- Service de gynécologie-obstétrique, CHU Saint-Jacques, 2, place Saint-Jacques, 25030 Besançon, France.
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Dhaifalah I, Santavy J, Fingerova H. Uterine rupture during pregnancy and delivery among women attending the Al-Tthawra Hospital in Sana'a City Yemen Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 150:279-83. [PMID: 17426793 DOI: 10.5507/bp.2006.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND About 20 percent of the population in developing countries is composed of women of reproductive age. These women face one of the catastrophic risks of pregnancy "uterine rupture". Studies conducted in the developing world give strong evidence that uterine rupture is a major health problem in these countries with the rate being high in rural areas. AIM The purpose of the study was to estimate the incidence and determine the risk factors and outcome of uterine rupture among women using the referral hospital Al-thawra in Sana'a City, Yemen republic and to extrapolate the data to the whole of Yemen. METHODS The data was collected retrospectively; by interviewing, examining and following up all the cases of uterine rupture coming to the hospital during a period of 9 months between September 1996 and May 1997. A descriptive analysis and distribution frequency of the commonest causes of uterine rupture in 37 cases are presented taking into account medical, reproductive, health services provided and sociodemographic factors. RESULTS Incidence of uterine rupture in Yemen was found to be (0.63), obstructed labor 83 %, contracted pelvis 19 %, previous surgery in 48 %, Oxytocine infusion in 42 %. Grand-multiparty was in 65 % and maternal age over 35 years in 50 %. Antenatal care was only in 34 %. CONCLUSION The high percentage of malpresentation, cephalopelvic disproportion, previous uterine surgery accompanied by the high percentage of use of Oxytocin in this study highlights very clearly the role of this medication in increasing the risk of uterine rupture in Yemen.
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Affiliation(s)
- Ishraq Dhaifalah
- Department of Human Genetic and Fetal Medicine, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic.
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35
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Matsuo K, Scanlon JT, Atlas RO, Kopelman JN. Staircase sign: A newly described uterine contraction pattern seen in rupture of unscarred gravid uterus. J Obstet Gynaecol Res 2008; 34:100-4. [DOI: 10.1111/j.1447-0756.2007.00709.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Wang YL, Su TH. Obstetric Uterine Rupture of the Unscarred Uterus: A Twenty-Year Clinical Analysis. Gynecol Obstet Invest 2006; 62:131-5. [PMID: 16675909 DOI: 10.1159/000093031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 03/09/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rupture of the unscarred uterus is a rare and potentially catastrophic event. We retrospectively reviewed the records of patients with this condition to analyze their obstetric and gynecologic history and evaluate maternal and perinatal morbidity and mortality. METHODS A total of 11 cases of rupture of the unscarred gravid uterus were managed at Mackay Memorial Hospital from January 1984 to September 2003. Data extracted from the records included the use of uterine stimulants, instrumental delivery, and prior abortion by instrumentation, clinical features, treatment, and maternal and fetal morbidity and mortality. RESULTS The incidence of unscarred uterine rupture is 0.009% during the 20-year study period. The most common contributing factors were prior abortion by instrumentation and the use of uterotonic agents, in three cases respectively. Fetal distress occurred in six cases and postpartum hemorrhage in two. There was no maternal death, but in two cases, there was intrauterine fetal demise or perinatal death. CONCLUSION Though unexpected in a woman with an unscarred uterus, rupture should be considered as a possible cause of fetal distress or unusual pain or hypotension in the mother.
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Affiliation(s)
- Yeou-Lih Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and Mackay Medicine, Nursing, and Management College, Taipei, Taiwan.
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37
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Affiliation(s)
- Mark B Landon
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH, USA.
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38
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Abstract
BACKGROUND Uterine rupture is a catastrophic obstetric complication. The main risk factor is a scarred uterus, usually secondary to a previous cesarean delivery. Uterine rupture in a primigravid woman is a very rare event. CASE A 33-year-old primigravida presented at term with severe abdominal pain, signs of hemodynamic instability, and fetal bradycardia. She was not in labor, and the fetal heart tones disappeared before a cesarean could be performed. After a failed attempt at induction, exploratory laparotomy was performed for worsening maternal hemodynamic status. A complete rupture of the posterior uterine wall was found with a well-grown fetus free in the abdominal cavity. The uterus was repaired in two layers, and the patient did well postoperatively. CONCLUSION We report the rare occurrence of a spontaneous uterine rupture in a nonlaboring primigravid with no known risk factors. The differential diagnosis of this presentation includes concealed placental abruption, subhepatic hematoma with or without liver rupture, splenic rupture, rupture of the broad ligament, and rupture of a uterine vein. Although uterine rupture occurs more commonly in the multiparous population, it cannot be assumed that the primigravid uterus is immune to rupture.
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Catanzarite V, Cousins L, Dowling D, Daneshmand S. Oxytocin-Associated Rupture of an Unscarred Uterus in a Primigravida. Obstet Gynecol 2006; 108:723-5. [PMID: 17018478 DOI: 10.1097/01.aog.0000215559.21051.dc] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intrapartum rupture of the unscarred uterus is an uncommon event, usually associated with such risk factors as grand multiparity, malpresentation, history of gestational trophoblastic disease, or instrumented delivery. Rupture during first pregnancy is extremely rare. CASE A 30-year-old primigravid woman was admitted for labor augmentation with oxytocin at 40.5 weeks of gestation. The oxytocin infusion rate was increased during the first and second stages of labor despite contractions occurring at a rate of 4-5 per 10 minutes. The uterus ruptured during second stage. Despite emergency cesarean delivery, the baby had evidence of severe asphyxia. CONCLUSION This case of uterine rupture in a primigravida with no prior uterine surgery and a structurally normal uterus underscores the importance of careful contraction monitoring and judicious control of oxytocin infusion rates.
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Affiliation(s)
- Val Catanzarite
- Maternal Fetal Medicine, San Diego Perinatal Center and Sharp Mary Birch Hospital for Women, San Diego, CA 92123, USA.
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Hruska KM, Coughlin BF, Coggins AA, Wiczyk HP. MRI diagnosis of spontaneous uterine rupture of an unscarred uterus. Emerg Radiol 2006; 12:186-8. [PMID: 16450162 DOI: 10.1007/s10140-005-0449-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 10/07/2005] [Indexed: 11/28/2022]
Abstract
Spontaneous uterine rupture is a rare, potentially catastrophic complication of pregnancy, and its prompt diagnosis and treatment are essential in limiting morbidity and mortality. Clinical diagnosis is difficult and relies heavily on diagnostic imaging. Radiological diagnosis is also often difficult with most documented cases involving the use of ultrasound and computed tomography. Although magnetic resonance imaging (MRI) is being used more frequently to assess patients, there are few reports illustrating the utility of MRI and its advantages over other imaging modalities in the diagnosis of uterine rupture. This report documents a case of spontaneous uterine rupture diagnosed by MRI in a postpartum patient with an unscarred uterus.
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Affiliation(s)
- Karim M Hruska
- Baystate Medical Center, Western Campus of Tufts University School of Medicine, Springfield, MA, USA
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Sun CH, Liao CI, Kan YY. “Silent” rupture of unscarred gravid uterus with subsequent pelvic abscess: Successful laparoscopic management. J Minim Invasive Gynecol 2005; 12:519-21. [PMID: 16337580 DOI: 10.1016/j.jmig.2005.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Revised: 06/17/2005] [Accepted: 07/08/2005] [Indexed: 12/01/2022]
Abstract
Intrapartum rupture of an unscarred uterus is rare in current times. However, it is still associated with significant maternal and fetal mortality and morbidity. Unlike rupture or dehiscence of a previous cesarean scar, which is occasionally bloodless, complete rupture of a gravid unscarred uterus frequently results in fetal jeopardy and significant maternal intraperitoneal bleeding, causes acute abdomen, and demands emergency surgical (laparotomy) intervention. Laparoscopy generally has no role in such circumstances due to the generally unstable maternal hemodynamic condition and the necessity of prompt fetal delivery with an abdominal approach. We present a rare case of intrapartum rupture of an unscarred gravid uterus with an atypical insidious clinical course. The diagnosis of complete uterine rupture was made 20 days after the patient's successful vaginal delivery, at which time a large pelvic abscess formed. The condition was successfully managed laparoscopically. Successful vaginal delivery, even with normal lochia, good uterine contraction, and stable vital signs, does not preclude the possibility of uterine rupture. For patients with unusual postpartum pelvic pain, uterine rupture should be considered as one of the possible etiologic factors, and prompt survey should be performed. Laparoscopic intervention may be valuable in such situations.
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Affiliation(s)
- Chung-hsien Sun
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Huang WC, Hung FY, Chen CP, Lin CJ. Spontaneous Rupture of an Unscarred Uterus Caused by Near-Cornual Pregnancy with Placenta Accreta at 4 Months of Pregnancy. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sentilhes L, Sergent F, Roman H, Verspyck E, Marpeau L. Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy. Eur J Obstet Gynecol Reprod Biol 2005; 120:134-8. [PMID: 15925040 DOI: 10.1016/j.ejogrb.2004.10.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Revised: 09/21/2004] [Accepted: 10/11/2004] [Indexed: 01/09/2023]
Abstract
The main purpose of this study was to identify predictors of uterine rupture following operative hysteroscopy. We also attempted to assess possible clinical or imaging methods in order to detect and avoid impending ruptures. A MEDLINE and EMBASE search of the English, German and French literatures was performed to retrieve case reports of uterine rupture following operative hysteroscopy. A total of 14 cases were retrieved. Twelve patients had a history of hysteroscopic metroplasty. Uterine perforation complicated operative hysteroscopy in eight cases and electrosurgery was used in nine cases. The interval between hysteroscopy and subsequent pregnancies varied from 1 month to 5 years with an average range of 16 months. Hysterosalpingogram follow-up was carried out in six cases and was considered normal in five cases. During pregnancy, serial ultrasound scans were performed in two cases to detect impeding rupture without success. Hysteroscopic metroplasty subjected patients to high risks of uterine rupture during subsequent pregnancies. Uterine perforation and/or the use of electrosurgery increase this risk but are not considered an independent risk factor. Uncomplicated hysteroscopic resection of submucous myomas and endometrial polyps did not alter obstetrical outcome. Apart from favourable use of scissors for hysteroscopic metroplasty, no accurate methods to prevent or detect impending ruptures in subsequent pregnancies were found. Physicians providing care for patients with previous hysteroscopic metroplasty or complicated operative hysteroscopy, should be aware of the potential risks for uterine rupture during pregnancy.
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Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynecology, Pavillon Mère-Enfant, Rouen University Hospital, Charles Nicolle, 1, rue de Germont, 76031 Rouen-Cedex, France.
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Wang YL, Su TH, Lee RKK. Obstetric Uterine Rupture: A 20-Year Clinical Analysis. Taiwan J Obstet Gynecol 2004. [DOI: 10.1016/s1028-4559(09)60070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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45
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Third-trimester Spontaneous Rupture of an Unscarred Uterus with Massive Intra-abdominal Hemorrhage During Tocolysis in a Pregnant Woman who has had Multiple Instrumental Abortions. Taiwan J Obstet Gynecol 2004. [DOI: 10.1016/s1028-4559(09)60080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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46
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Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: differences between a scarred and an unscarred uterus. Am J Obstet Gynecol 2004; 191:425-9. [PMID: 15343216 DOI: 10.1016/j.ajog.2004.01.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to compare risk factors, site of rupture, and outcome of uterine rupture among patients with a scarred versus an unscarred uterus. Study design We conducted a comparison between all cases of uterine rupture (n=53) in women with a scarred versus an unscarred uterus, occurring between January 1988 and July 2002. RESULTS During the study period, there were ruptures among 26 patients with a scarred uterus and 27 patients without a uterine scar. No significant differences were noted between the scarred and unscarred groups while comparing risk factors such as birth order, birth weight, hydramnios, oxytocin induction, diabetes, and malpresentation. The main site of involvement in both groups was the lower uterine segment representing 92.6% of the ruptures in the unscarred group and 92.3% of the ruptures in the scarred uterus group. Cervical involvement was significantly more common among patients without a previous uterine scar (33.3% vs 7.7%; odds ratio [OR]=6.0, 95% CI, 1.16-31.23, P=.04). Conversely, uterus corpus involvement did not differ between the groups. Perinatal mortality did not differ between the groups. In addition, no significant differences were noted regarding maternal morbidity such as the need for hysterectomy, blood transfusion, or length of hospitalization. CONCLUSION Although cervical involvement was significantly more prevalent in the rupture of an unscarred uterus, no significant differences in maternal or perinatal morbidity were noted between rupture of a scarred versus an unscarred uterus.
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Affiliation(s)
- Keren Ofir
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gutiérrez-García S, Lamoca A, Casasola J, Salas S, García-Merayo M, Hernández-Rodrguez J. Rotura uterina espontánea en útero no cicatrizal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ahmadi S, Nouira M, Bibi M, Boughuizane S, Saidi H, Chaib A, Khairi H. [Uterine rupture of the unscarred uterus. About 28 cases]. ACTA ACUST UNITED AC 2003; 31:713-7. [PMID: 14499715 DOI: 10.1016/s1297-9589(03)00212-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine the etiologic factors explaining the appearance of uterine rupture on unscarred gravid uterus and to value the maternal and foetal prognosis of this complication. PATIENTS AND METHODS The authors report a study of 28 cases of uterine rupture on unscarred gravid uterus, recorded between January 1989 and December 1997, at the department of obstetrics and gynecology, Farhat Hached University Hospital, Sousse, Tunisia. RESULTS Out of the 72283 deliveries during the study period, there were 28 ruptured uteri of unscarred uterus giving a hospital incidence of one in 2581 deliveries. Multiparity, neglected labour dystocia and obstetric procedure were the common etiologic factors accused in the occurring of this complication. To be added to these factors: the low socio-economic status of the patients and lack of antenatal care. The surgical management was conservative (repair) in 19 cases (67.9%); hysterectomy was indicated in nine cases (32.1%). Maternal and fetal morbidity and mortality were important: we deplore two maternal deaths (7.1%) and seven fetal deaths (24.1%). DISCUSSION AND CONCLUSION Uterine rupture on unscarred uterus is a relatively rare complication of the pregnancy. However, its incidence remains high in developing countries. Its occurrence is significantly associated with grandmultiparity, lack of antenatal care and low socio-economic status of the patients.
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Affiliation(s)
- S Ahmadi
- Service de gynécologie-obstétrique, CHU Farhat-Hached de Sousse, 4000 Sousse, Tunisie
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Abstract
Uterine atony, inversion, and rupture are potentially fatal events that may occur in pregnancy. They are obstetric emergencies that require immediate attention. Although all women may experience these complications, identification or known risk factors allow the obstetric team to prepare for rapid diagnosis and intervention. This article includes management options to help prepare for these uncommon events.
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Affiliation(s)
- D L Ripley
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, USA
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50
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Welsh AW, Smith J. Antenatal uterine rupture in a primigravida (associated with undisclosed previous uterine surgery). Aust N Z J Obstet Gynaecol 1999; 39:368-70. [PMID: 10554956 DOI: 10.1111/j.1479-828x.1999.tb03419.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A W Welsh
- Department of Obstetrics and Gynaecology, Women's and Children's Healthcare Network, Western Hospital, Sunshine, Melbourne
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