1
|
Alhalak F, Haddad S, Nasseh G, Nasseh M, Marroush J, Abaza R, AlSafadi A, Hani MJDB, Kabbabe GM. A cesarean section scar dehiscence during the first trimester of an intrauterine pregnancy: a rare case report and literature review. J Surg Case Rep 2024; 2024:rjae422. [PMID: 38912433 PMCID: PMC11190852 DOI: 10.1093/jscr/rjae422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024] Open
Abstract
Uterine rupture is specified as a complete laceration of the uterine wall, including its serosa, leading to a connection between the endometrial and peritoneal chambers. It can occur in any stage of pregnancy and is considered a severe and perhaps fatal complication. A 35-year-old woman at 9 weeks of gestation with a medical history of five prior cesarean sections presented with lower abdominal pain that had lasted for 5 hr. We detected small amounts of free fluid in the Douglas pouch using ultrasound. Subsequently, a laparotomy revealed a cesarean scar dehiscence from a non-cesarean scar pregnancy. Patients who experience a uterine rupture may have vague symptoms, severe abdominal discomfort, abnormal uterine bleeding, and severe hemorrhagic shock, depending on their gestational age. Ultrasound imaging can be used to diagnose this fatal condition in addition to laparoscopy to immediately identify and treat the issue in urgent cases.
Collapse
Affiliation(s)
- Fadi Alhalak
- University Hospital of Obstetrics and Gynecology in Damascus, G76Q+3RH, Damascus, Syrian Arab Republic
| | - Sultaneh Haddad
- Children's Hospital Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Gabriel Nasseh
- University of Aleppo Faculty of Medicine, 646G+8FG, Aleppo, Syrian Arab Republic
| | - Mira Nasseh
- University of Aleppo Faculty of Medicine, 646G+8FG, Aleppo, Syrian Arab Republic
| | - Joud Marroush
- Syrian Private University, M5, Damascus, Syrian Arab republic
| | - Rami Abaza
- Damascus University Faculty of Medicine, G748+VRH, Damascus, Syrian Arab Republic
| | - Aya AlSafadi
- Syrian Private University, M5, Damascus, Syrian Arab republic
| | | | | |
Collapse
|
2
|
Perdue M, Felder L, Berghella V. First-trimester uterine rupture: a case report and systematic review of the literature. Am J Obstet Gynecol 2022; 227:209-217. [PMID: 35487324 DOI: 10.1016/j.ajog.2022.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to present a case of first-trimester uterine rupture and perform a systematic review to identify common presentations, risk factors, and management strategies. DATA SOURCES Searches were performed in PubMed, Ovid, and Scopus using a combination of key words related to "uterine rupture," "first trimester," and "early pregnancy" from database inception to September 30, 2020. STUDY ELIGIBILITY CRITERIA English language descriptions of uterine rupture at ≤14 weeks of gestation were included, and cases involving pregnancy termination and ectopic pregnancy were excluded. METHODS Outcomes for the systematic review included maternal demographics, description of uterine rupture, and specifics of uterine rupture diagnosis and management. Data were extracted to custom-made reporting forms. Median values were calculated for continuous variables, and percentages were calculated for categorical variables. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for case reports and case series. RESULTS Overall, 61 cases of first-trimester uterine rupture were identified, including our novel case. First-trimester uterine ruptures occurred at a median gestation of 11 weeks. Most patients (59/61 [97%]) had abdominal pain as a presenting symptom, and previous uterine surgery was prevalent (44/61 [62%]), usually low transverse cesarean delivery (32/61 [52%]). The diagnosis of uterine rupture was generally made after surgical exploration (37/61 [61%]), with rupture noted in the fundus in 26 of 61 cases (43%) and in the lower segment in 27 of 61 cases (44%). Primary repair of the defect was possible in 40 of 61 cases (66%), whereas hysterectomy was performed in 18 of 61 cases (30%). Continuing pregnancy was possible in 4 of 61 cases (7%). CONCLUSION Uterine rupture is an uncommon occurrence but should be considered in patients with an acute abdomen in early pregnancy, especially in women with previous uterine surgery. Surgical exploration is typically needed to confirm the diagnosis and for management. Hysterectomy is not always necessary; primary uterine repair is sufficient in more than two-thirds of the cases to achieve hemostasis. Continuing pregnancy, although uncommon, is also possible.
Collapse
Affiliation(s)
- Makenzie Perdue
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Laura Felder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
| |
Collapse
|
3
|
Iino K, Tanaka K, Takabayashi A, Akaishi A, Ishihara K, Yokoyama Y. Spontaneous partial uterine laceration in primigravida at 16 weeks of gestation: A case report. Int J Surg Case Rep 2020; 73:154-156. [PMID: 32688236 PMCID: PMC7369449 DOI: 10.1016/j.ijscr.2020.07.006] [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: 06/09/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022] Open
Abstract
Uterine laceration is extremely rare and little known, however it sometimes causes massive intraperitoneal bleeding and has poor prognosis. Inner myometrial laceration may be caused by intrapartum physical stress, whereas uterine laceration in relatively early pregnancy might be occurred by tissue inadaptable for uterine enlargement. To diagnosis uterine laceration in early pregnancy is quite difficult because of the absence of specific clinical findings. Not only uterine rupture but also uterine laceration should be considered, and exploratory laparotomy should be performed appropriately when hemoperitoneum is strongly suspected.
Introduction Although uterine rupture is well discussed, uterine laceration and partial myometrial laceration are little known. A previous report hypothesized that the stress of labor was associated with uterine laceration. Presentation of case We present a rare case of uterine laceration in a patient in the second trimester. A 34-year-old primigravida woman at 16 weeks’ gestation without a history of uterine surgery complained of sudden low abdominal pain. Ultrasonography showed fetal death and intraperitoneal free fluid. A laparotomy was performed, and partial uterine laceration in the posterior wall along with active bleeding was confirmed. Discussion The etiology of uterine laceration in early pregnancy might be different from both classical uterine rupture and previously published uterine laceration. We hypothesized that tissue inadaptable for uterine enlargement, such as that owing to endometriosis and subtle injury by surgical approach, may be associated with the onset mechanism. Conclusion The diagnosis of uterine laceration in early pregnancy is quite difficult because of the absence of specific clinical findings. However, it sometimes causes massive intraperitoneal bleeding and has poor prognosis. Therefore, when uterine laceration is suspected as a cause of hemoperitoneum in a pregnant women, clinicians should perfume exploratory laparotomy appropriately.
Collapse
Affiliation(s)
- Kaori Iino
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori, 036-8562, Japan; National Hospital Organization Hirosaki National Hospital, Japan.
| | - Kanji Tanaka
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori, 036-8562, Japan
| | - Anna Takabayashi
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori, 036-8562, Japan
| | - Asami Akaishi
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori, 036-8562, Japan
| | - Kana Ishihara
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori, 036-8562, Japan
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori, 036-8562, Japan
| |
Collapse
|
4
|
First Trimester Uterine Rupture: A Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082976. [PMID: 32344763 PMCID: PMC7215710 DOI: 10.3390/ijerph17082976] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
The aim is to report a case of spontaneous uterine rupture in the first trimester of pregnancy and to review the literature on the topic. METHODS A literature search was performed using PubMed and Scopus. Relevant English articles were identified without any time or study limitations. The data were aggregated, and a summary statistic was calculated. RESULTS A 35-year-old gravida 5, para 2 was admitted at our department because of fainting and abdominal pain. The woman had a first-trimester twin pregnancy and a history of two previous cesarean sections (CSs). Suspecting a uterine rupture, an emergency laparotomy was performed. The two sacs were completely removed, and the uterine rupture site was closed with a double-layer suture. The patient was discharged from hospital four days later in good condition. On the basis of this experience, a total of 76 case reports were extracted from PubMed and included in the review. Fifty-three patients out of 76 (69.74%) underwent previous surgery on the uterus. Most women (67.92%) had a CS, and in this group a cesarean scar pregnancy (CSP) or a placenta accreta spectrum (PAS) disorder was found to be the etiology in 77.78% of cases. Furthermore, 35.85% of the women had hysterectomy after uterine rupture. Twenty-three patients out of 76 (30.26%) had an unscarred uterus. Of this group, most women presented a uterine anomaly (43.48%). Moreover, 17.39% of these women had a hysterectomy. CONCLUSION According to the literature, the current pandemic use of CS explains most cases of first-trimester uterine rupture.
Collapse
|
5
|
Singh R, Pradeep Y. Maternal and neonatal outcomes in morbidly adherent placenta: a developing country experience. Trop Doct 2015; 45:183-7. [PMID: 25979844 DOI: 10.1177/0049475515585639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Morbid adherent placenta, a severe pregnancy complication, is associated with massive obstetrical haemorrhage and high maternal mortality. Antenatal diagnosis and meticulous multidisciplinary planning at delivery is crucial for optimal outcome. We aim to identify the maternal and neonatal outcome in women with morbid adherent placenta. METHOD It was a retrospective evaluation of cases of clinically suspected and/or histologically confirmed morbid adherent placenta over a 1-year period. RESULTS The incidence of morbid adherent placenta was 1 per 306 deliveries. Previous Caesarean section with placenta praevia was the commonest risk factor. Among all, 71.4% had no antenatal care. Of all, 38.9% women needed transfer to critical care. There were five (23.8%) maternal deaths. Of the 21 neonates, four were stillborn, nine needed NICU transfer and eight had an Apgar score of 9 at 5 min of birth. CONCLUSION Morbid adherent placenta is associated with poor maternal and neonatal outcome.
Collapse
Affiliation(s)
- Renu Singh
- Associate Professor, Department of Obstetrics & Gynecology, King George's Medical University, Lucknow, India
| | - Yashodhara Pradeep
- Professor, Department of Obstetrics & Gynecology, King George's Medical University, Lucknow, India
| |
Collapse
|
6
|
First trimester spontaneous uterine rupture in a young woman with uterine anomaly. Case Rep Obstet Gynecol 2014; 2014:967386. [PMID: 24551467 PMCID: PMC3914315 DOI: 10.1155/2014/967386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022] Open
Abstract
Spontaneous uterine rupture is a life-threatening obstetrical emergency carrying a high risk for the mother and the fetus. Spontaneous uterine rupture in early pregnancy is very rare complication and it occurs usually in scarred uterus. Uterine anomalies are one of the reasons for spontaneous unscarred uterine rupture in early pregnancy. Obstetricians must consider this diagnosis when a pregnant patient presented with acute abdomen in early pregnancy. We present a case of spontaneous uterine rupture at 12 weeks of gestation in 24-year-old multigravida who had uterine anomaly presenting as an acute abdomen. Our preoperative diagnosis was ectopic pregnancy. Emergency laparotomy confirmed a spontaneous uterine rupture. Uterine anomaly is a risk factor for spontaneous uterine rupture in the early pregnancy. Clinical signs of uterine rupture in early pregnancy are nonspecific and must be distinguished from acute abdominal emergencies.
Collapse
|
7
|
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]
|
8
|
Chen BA, Reeves MF, Creinin MD, Gilles JM, Barnhart K, Westhoff C, Zhang J. Misoprostol for treatment of early pregnancy failure in women with previous uterine surgery. Am J Obstet Gynecol 2008; 198:626.e1-5. [PMID: 18279821 DOI: 10.1016/j.ajog.2007.11.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 10/06/2007] [Accepted: 11/21/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Misoprostol use in early pregnancy may incur a risk of uterine rupture in women with previous uterine surgery. STUDY DESIGN We analyzed 488 women who received misoprostol 800 microg vaginally in a study that evaluated medical and surgical management of early pregnancy failure. Subjects received a repeat misoprostol dose if expulsion was not confirmed 2 days after treatment. We compared efficacy, acceptability, and safety in subjects with a history (n = 78 women) or absence (n = 410 women) of uterine surgery, defined as cesarean delivery or myomectomy. RESULTS Expulsion rates after a single misoprostol dose (69% vs 72%; P = .64) and overall success at 30 days (82% vs 85%; P = .50) were comparable. Pain, bleeding, complications, and acceptability did not differ. No uterine ruptures occurred (95% CI, 0, 3.8%). CONCLUSION Misoprostol treatment for early pregnancy failure had similar success, acceptability, and complications in women with and without previous uterine surgery.
Collapse
Affiliation(s)
- Beatrice A Chen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, and Magee-Womens Research Institute, Pittsburgh, PA, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Lubner M, Menias C, Rucker C, Bhalla S, Peterson CM, Wang L, Gratz B. Blood in the belly: CT findings of hemoperitoneum. Radiographics 2007; 27:109-25. [PMID: 17235002 DOI: 10.1148/rg.271065042] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hemoperitoneum may occur in various emergent conditions. In the trauma setting, evidence of intraperitoneal blood depicted at computed tomography (CT) should lead the radiologist to conduct a careful search of images for the injured visceral organ (the liver or spleen). Specific CT signs, such as a sentinel clot or extravasation of intravascular contrast material, may indicate the source of bleeding and help direct management. In addition, the configuration of accumulated blood may help identify the injured organ; for example, triangular fluid collections are observed in the mesentery most often in the setting of bowel or mesenteric injury. Less commonly, hemoperitoneum may have a nontraumatic origin. Iatrogenic hemoperitoneum may occur as a complication of surgery or other interventional procedures in the abdominal cavity or as a result of anticoagulation therapy. Hemoperitoneum also may be seen in the setting of blood dyscrasias such as hemophilia and polycythemia vera. Tumor-associated hemorrhage, which most often occurs in hepatocellular carcinoma, hepatic adenoma, or vascular metastatic disease, also may produce hemoperitoneum. Other potential causes of nontraumatic hemoperitoneum are gynecologic conditions such as hemorrhage or rupture of an ovarian cyst and rupture of the gestational sac in ectopic pregnancy, and hepatic hematoma in syndromic hemolysis with elevated liver enzymes and low platelet count (HELLP syndrome). Vascular lesions (visceral artery aneurysms and pseudoaneurysms) that occur in systemic vascular diseases such as Ehlers-Danlos syndrome or in pancreatitis are another less common source of hemoperitoneum.
Collapse
Affiliation(s)
- Meghan Lubner
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110, USA.
| | | | | | | | | | | | | |
Collapse
|
10
|
|