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Hawkins L, Robertson D, Frecker H, Berger H, Satkunaratnam A. Spontaneous uterine rupture and surgical repair at 21 weeks gestation with progression to live birth: a case report. BMC Pregnancy Childbirth 2018; 18:132. [PMID: 29728141 PMCID: PMC5935985 DOI: 10.1186/s12884-018-1761-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/23/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Uterine rupture in the non-laboring uterus is a rare occurrence, which can lead to significant morbidity and mortality for the mother and fetus. Management of this presentation is complex at pre-viable gestations. CASE PRESENTATION A 35 year old primigravid woman with multiple previous myomectomies presented with spontaneous complete thickness uterine rupture at 21 weeks gestation. A 10 cm myometrial defect and iatrogenic amniotomy were surgically corrected with fetal preservation. This led to pregnancy continuation to 32 weeks gestation when elective cesarean delivery resulted in excellent neonatal outcome. CONCLUSIONS Early surgical diagnosis, multidisciplinary team approach, iatrogenic amniotomy and continuous two-layer myometrial closure were factors that contributed to pregnancy prolongation in this large myometrial rupture.
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Affiliation(s)
- Lesley Hawkins
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada
| | - Deborah Robertson
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada
| | - Helena Frecker
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, Michael Garron Hospital, Suite 311, 658 Danforth Avenue, M4J5B9, Toronto, Ontario, Canada
| | - Howard Berger
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada
| | - Abheha Satkunaratnam
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada. .,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada.
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Surico D, Amadori R, Vigone A, D'Agostino C, Dessole M, Surico N. Successful delivery after surgical repair of uterine rupture at 15 weeks of gestation: case report and brief review. Eur J Obstet Gynecol Reprod Biol 2016; 204:5-8. [PMID: 27459146 DOI: 10.1016/j.ejogrb.2016.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/15/2016] [Accepted: 05/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Second-trimester uterine rupture is a rare disorder and it is unclear if it should be managed with caesarean section, repair or hysterectomy. This article provides a case report of second-trimester uterine rupture repair, and reviews the risk factors, signs and symptoms, suturing technique and newborn outcome. METHODS PubMed was searched using the terms 'uterine rupture', 'second trimester' and 'repair' Only cases of second-trimester uterine rupture repair that led to successful prolongation of pregnancy were included. RESULTS The main risk factor of uterine rupture is previous caesarean section (5/10, 50%). Eight of 10 cases presented with abdominal pain and three cases presented in shock. Haemoperitoneum was present in five cases. The mean and median gestational age at delivery were 33.4 and 33.5 weeks, respectively (range 28-37 weeks), with mean and median delayed interval delivery of 95.5 and 91 days, respectively (range 14-147 days). Neonatal outcome was good for 10 of 11 newborns. Despite the early onset of uterine rupture, there were no cases of extremely preterm delivery. One early preterm infant, seven moderate-to-late preterm infants and one term infant were delivered. CONCLUSIONS The lack of extremely preterm deliveries and good neonatal outcomes encourage attempts to repair the uterus after second-trimester rupture.
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Affiliation(s)
- D Surico
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy
| | - R Amadori
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy.
| | - A Vigone
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy
| | - C D'Agostino
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy
| | - M Dessole
- Department of Surgical, Microsurgical and Medical Sciences, Gynaecologic and Obstetric Clinic, University of Sassari, Sassari, Italy
| | - N Surico
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy
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Iemura A, Kondoh E, Kawasaki K, Fujita K, Ueda A, Mogami H, Baba T, Konishi I. Expectant management of a herniated amniotic sac presenting as silent uterine rupture: a case report and literature review. J Matern Fetal Neonatal Med 2014; 28:106-12. [DOI: 10.3109/14767058.2014.900533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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