Extrusion of fetus into the abdominal cavity following complete rupture of uterus: a case report

Rupture-mediated large uterine defect at 30th gestational week with protruded amniotic sac and fetal head without fetal compromise after laparoscopic electromyolysis: Case report and literature review

BACKGROUND

We describe a case of a rupture-mediated large uterine defect, which occurred on the 30th gestation week presenting a protruding amniotic sac sac without fetal compromise after a laparoscopic electromyolysis.

CASE PRESENTATION

A 28-year-old woman in her 30th week of gestation (gravida 2, para 0) presented with whole abdominal and right lower quadrant pain at Sanggye Paik Hospital. Ultrasound examination showed normal amniotic fluid and placentation but with breech presentation. She had undergone laparoscopic right ovarian cystectomy due to endometriosis 5 years earlier. Cardiotocography revealed an intermittent variable deceleration and no uterine contraction. Magnetic resonance imaging ruled out acute appendicitis. Four hours later, we observed a protrusion of the amniotic sac with the fetal head through a large uterine defect on magnetic resonance imaging, and performed emergency cesarean section. A boy was delivered without fetal compromise. During the cesarean section, multiple myometric wall defects and thinning were identified. After reconstruction of the uterine wall, the flaccid uterus bled persistently; thus, a cesarean hysterectomy was performed. Packed red cells and frozen plasma were transfused. The mother and neonate had uneventful puerperal and neonatal courses, respectively. After cesarean hysterectomy, we were informed that the mother had undergone a combined laparoscopic electromyolysis during the laparoscopic right ovarian cystectomy. Three years later, the child showed normal neural development.

CONCLUSIONS

Before myomectomy or electromyolysis, patients should be informed of the possibility of uterine rupture during subsequent pregnancies. If a pregnant woman has abdominal pain, clinicians should take a detailed history of uterine surgery and consider uterine rupture. Although, fortunately, the outcomes in this case were uneventful, urgent delivery is required when uterine rupture is diagnosed.

Spontaneous Rupture in a Non-Laboring Uterus at 20 Weeks: A Case Report

Patient: Female, 31-year-old

Final Diagnosis: Uterine rupture secondary to placenta percreta

Symptoms: Acute abdomen

Medication: —

Clinical Procedure: Laparotomy and subtotal hysterectomy

Specialty: Obstetrics and Gynecology

Prelabor uterine rupture and extrusion of fetus with intact amniotic membranes: a case report

Introduction: The increasing rate of cesarean sections is an important issue globally, especially in developed countries. During the last decade, despite decreasing rates of vaginal delivery attempts after a previous cesarean section, the risk of uterine rupture has remained. Uterine rupture is a significant and catastrophic obstetric complication associated with maternal and fetal morbidity and mortality. We report here a very rare case of prelabor uterine rupture with intact membranes.

Case report: A 28-year-old, gravida 3, para 2 Turkish woman was referred to our emergency unit at 34 weeks’ gestation because of the absence of fetal movements and abdominal pain. She had had a vaginal birth in 2007 and a cesarean section in 2009. In the delivery room, the fetal extremities were palpated at the abdominal wall, and an ultrasonography revealed ruptured uterus and fetal death. A midline laparotomy was carried out to open the peritoneal cavity. An intact amniotic sac with fetus was observed in the abdominal cavity, and the uterus was also observed to be ruptured. The male fetus, weighing 2500 g, was dead. The rupture was extending from the left lateral side of cervix to the fundus. The tear was repaired by primarily suturing the uterus in two layers after ligation of the left uterine artery to control hemorrhage. The total estimated blood loss was about 1300 mL. The patient received two units of blood transfusion during the operation. In the 4th postoperative day, the patient was discharged.

Conclusion: Complete uterine rupture is a rare but catastrophic event, and if diagnosed late, can result in mortality. Uterine rupture is rare during a trial of vaginal labor in a patient with a history of cesarean section; it is much rarer to occur before any trial of vaginal labor in such a patient. If a patient with a history of cesarean section, especially with an unknown type of incision, presents with complaints of abdominal tenderness or vaginal bleeding in the 3rd trimester, the possibility of complete uterine rupture must be considered.

Preterm spontaneous uterine rupture in a non-labouring grand multipara: a case report

BACKGROUND

Uterine rupture can be a catastrophic obstetrical emergency. Many risk factors for uterine rupture have been identified, as well as a wide range of clinical presentations. In this case report, we describe the occurrence of fetal death and uterine rupture in a non-labouring, preterm patient.

CASE

A 32-year-old woman, gravida 10, para 7, who had three previous lower segment Caesarean sections, presented with minor abdominal pain and vaginal bleeding. Fetal demise was confirmed on ultrasound examination. Delivery of the fetus by lower segment Caesarean section was planned, but at laparotomy a complete uterine rupture was found, with the amniotic sac intact in the mother's abdomen.

CONCLUSION

Uterine rupture can be a fatal event for the fetus, with the mother experiencing only minor symptoms. In managing patients with risk factors for uterine rupture, clinicians must always keep the possibility of rupture in mind. Abdominal trauma and intercourse may be added risk factors for uterine rupture.