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Abstract
Abstract
Background
Uterine rupture is an extremely rare and unpredictable event for women undergoing trial of labor after cesarean delivery (TOLAC).
Case presentation
We present a patient with a lateral edge uterine rupture after TOLAC and our modified surgical technique for preventing complications of uterine atony.
Conclusion
Further case report studies are required in order to evaluate the effectiveness of our new-modified surgical technique in appropriate selected cases.
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Smid MC, Waltner-Toews R, Goodnight W. Spontaneous Posterior Uterine Rupture in Twin-Twin Transfusion Syndrome. AJP Rep 2016; 6:e68-70. [PMID: 26929874 PMCID: PMC4737637 DOI: 10.1055/s-0035-1566243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background The maternal and fetal risks of uterine distension in rapidly progressive twin-twin transfusion syndrome (TTTS) in the setting of prior uterine scar are poorly characterized. Case We present the case of a 42-year-old woman, G4P1201, at 21 weeks gestation with stage-1 TTTS who developed a spontaneous posterior uterine rupture necessitating emergent laparotomy and delivery of previable fetuses, possibly due to prior uterine scar from a displaced intrauterine device. Conclusion TTTS may be a risk factor for uterine rupture, including uterine rupture in atypical anatomic locations. Prior unrecognized uterine scars, including perforations, may magnify the risk for atypical uterine rupture in the setting of excessive uterine distension.
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Affiliation(s)
- Marcela C Smid
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Rebecca Waltner-Toews
- Department of Obstetrics and Gynecology, University of Pittsburgh, Magee Women's Hospital, Pittsburgh, Pennsylvania
| | - William Goodnight
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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Revicky V, Muralidhar A, Mukhopadhyay S, Mahmood T. A Case Series of Uterine Rupture: Lessons to be Learned for Future Clinical Practice. J Obstet Gynaecol India 2013; 62:665-73. [PMID: 24293845 DOI: 10.1007/s13224-012-0328-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 07/11/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE In this article, we try to discuss risk factors and diagnostic difficulties for uterine rupture. METHODS Case series of 12 cases of uterine rupture observed in the Norfolk and Norwich University Hospital in the UK, with an average yearly birth rate of 6,000 deliveries, over a 6-year period. RESULTS In the present case series, there was no maternal mortality, and uterine rupture was a rare occurrence (12 in 36,000 births). Uterine rupture is associated with clinically significant uterine bleeding, fetal distress, expulsion or protrusion of the fetus, placenta or both into the abdominal cavity, and the need for prompt cesarean delivery and uterine repair or hysterectomy. The risk factors for rupture include previous cesarean sections, multiparity, malpresentation and obstructed labor, uterine anomalies, and use of prostaglandins for induction of labor. Previous cesarean section is, however, the most commonly associated risk factor. The most consistent early indicator of uterine rupture is the onset of a prolonged, persistent, and profound fetal bradycardia. CONCLUSION In this case series, we suggest that the signs and symptoms of uterine rupture are typically nonspecific, which makes diagnosis difficult. Delay in definitive therapy causes significant fetal morbidity. The inconsistent signs and the short time in prompting definitive treatment of uterine rupture make it a challenging event. For the best outcome, vaginal birth after previous cesarean section needs to be looked after in an appropriately staffed and equipped unit for an immediate cesarean delivery and advanced neonatal support.
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Affiliation(s)
- Vladimir Revicky
- Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY UK
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Posterior uterine rupture causing fetal expulsion into the abdominal cavity: a rare case of neonatal survival. Case Rep Obstet Gynecol 2011; 2011:426127. [PMID: 22567509 PMCID: PMC3335479 DOI: 10.1155/2011/426127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 08/21/2011] [Indexed: 11/18/2022] Open
Abstract
Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby. Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response.
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Figueroa R, Garry D, Mackenzie AP. Posterior uterine rupture in a woman with a previous Cesarean delivery. J Matern Fetal Neonatal Med 2009; 14:130-1. [PMID: 14629095 DOI: 10.1080/jmf.14.2.130.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 33-year-old primipara with a previous low transverse Cesarean delivery underwent labor induction at 41 weeks' gestation with a 10-mg dinoprostone vaginal insert. Eleven hours later, with the cervix fully dilated, an emergency Cesarean delivery was performed because of repetitive variable decelerations followed by fetal bradycardia. A posterior uterine wall rupture extending from the fundus to the vagina was repaired in layers. The neonate had an Apgar score of 2 and 4 and expired on the 7th day of life.
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Affiliation(s)
- R Figueroa
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, New York, USA
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Al Bar H, Sobande A, Hussein O, Thiga R, Mushait M. The experience with prostaglandin E2 vaginal tablets for induction of labour in grand and great grand multiparae. A two year review in Saudi Arabia. J OBSTET GYNAECOL 2009; 20:132-5. [PMID: 15512499 DOI: 10.1080/01443610062869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In an attempt to review our experience with prostaglandin E2 vaginal tablets in induction of labour in grandmultiparae (parity 5-9) and great grandmultiparae (parity > 9) a retrospective study was carried out at King Faisal Military Hospital in Saudi Arabia over a 2-year period. An evaluation of our protocol for induction of labour using prostaglandin in these groups of patients was also made. The patients included 271 grandmultiparae and 63 great grandmultiparae. There were no serious side effects in our series referable to the prostaglandin induction. There were no significant differences in the two groups regarding the mean total dose of prostaglandin used, mean length of second stage of labour, mean birth weight and admission to the neonatal intensive care unit (P > 0.05). However, the need for syntocinon augmentation was more in the great grandmultiparae (29% vs. 19%) but this was not significant statistically (P = 0.64). The caesarean section rate was higher in the great grandmultiparae (14% vs.10%) but not statistically significant (P = 0.19). None of the babies in the study group had an Apgar score less than 7 at 5 minutes. This study has shown that it may be safe to use prostaglandin E2 vaginal tablets for induction of labour in grandmultiparae and great grandmultiparae in our environment although the sample size may not be large enough to draw definite conclusions. Our protocol of stepwise increase in prostaglandin dose did not increase maternal or fetal morbidity but might actually have reduced the number of caesarean sections performed and therefore maternal mortality associated with caesarean section in the grandmultiparae. A multicentre prospective trial is eagerly awaited.
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Affiliation(s)
- H Al Bar
- Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Abha, Kingdom of Saudi Arabia
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Shantha N, Depares J. An unusual case of tear in the pouch of Douglas following spontaneous vaginal delivery in a previously scarred uterus. J OBSTET GYNAECOL 2009; 27:87-8. [PMID: 17365473 DOI: 10.1080/01443610601062952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- N Shantha
- Department of Obstetrics and Gynaecology, Stepping Hill Hospital, Stockport, UK.
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Singh Y, Chari VRR, Basu SK, Ratnam A. Cornual Rupture of Uterus. Med J Armed Forces India 2008; 64:81. [PMID: 27408091 PMCID: PMC4921748 DOI: 10.1016/s0377-1237(08)80161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 04/11/2007] [Indexed: 11/22/2022] Open
Affiliation(s)
- Y Singh
- Reader (Department of Obstetrics and Gynaecology), AFMC, Pune
| | - VRR Chari
- Ex-Senior Advisor (Anaesthesiology), 158 Base Hospital C/o 99APO
| | - SK Basu
- Ex-Senior Advisor (Obstetrics and Gynaecology), Command Hospital (EC), Kolkata
| | - A Ratnam
- Medical Officer, 14 BRTF, C/o 99 APO
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Majumdar S, Warren R, Ifaturoti O. Fetal survival following posterior uterine wall rupture during labour with intact previous caesarean section scar. Arch Gynecol Obstet 2007; 276:537-40. [PMID: 17440745 DOI: 10.1007/s00404-007-0365-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Accepted: 03/22/2007] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Posterior wall rupture of the uterus in presence of previous caesarean scar is an extremely rare and unpredictable event. CASE REPORT A 26-year old lady in her second pregnancy went into spontaneous labour at 41 weeks gestation. She had emergency caesarean section in her previous pregnancy. She made slow progress in labour to full dilatation without augmentation, but was noted to have fresh vaginal bleeding and breakthrough pain despite an epidural. Uterine scar rupture was suspected and an emergency lower segment caesarean section was carried out. Fresh intraperitoneal bleeding was noted but with an intact previous scar. The baby was delivered in good condition. A vertical posterior uterine wall rupture of the lower segment, 5 cm in length, was found to be bleeding profusely and was successfully repaired. DISCUSSION Uterine rupture is a rare but serious complication. Usually the rupture occurs through the previous uterine scar. There are only four reported cases in the literature of posterior uterine rupture in labour through "healthy" uterine tissue in women with previous caesarean section. This is the first instance of fetal survival. The exact mechanism is unknown but likely to be a combination of factors including prostaglandin use, element of obstruction and strong inelastic scar. CONCLUSION Strict vigilance is required during labour in women with previous scar. Early recognition of imminent scar rupture should speed delivery and improve the outcome for mother and baby.
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Affiliation(s)
- Subrata Majumdar
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
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Singhal SR, Agarwal U, Sangwan K, Khosla A, Singhal S. Intrapartum posterior uterine wall rupture in lower segment cesarean section scarred uterus. Acta Obstet Gynecol Scand 2005; 84:196-7. [PMID: 15683383 DOI: 10.1111/j.0001-6349.2005.0255a.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Savita Rani Singhal
- Department of Obstetrics and Gynecology, Post-Graduate Institute of Medical Sciences, Rohtak-124001, Haryana, India.
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Hamsho A, Alloub M. Spontaneous rupture of a 13 week gravid scarred uterus. J OBSTET GYNAECOL 2004; 19:316-7. [PMID: 15512312 DOI: 10.1080/01443619965237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- A Hamsho
- Women's Hospital, Hamad Medical Corporation, Doha, Qatar
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Alsakka M, Dauleh W, Tamimi H. Our Experience with Vaginal Prostaglandin-E2 for Induction of Labor in Qatar: Six Months Review. Qatar Med J 2003. [DOI: 10.5339/qmj.2003.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In order to review our experience with prostaglandin-E2 for the induction of labour and to evaluate its safety and outcomesa retrospective study was carried out at the Women's Hospital, Hamad Medical Corporation, over a six-month period. Three hundred and thirty four patients (7% of total deliveries) were induced by PGE2 (Dinoprostone), including 105 (30%) nulliparae and 229 (70%) multiparae. Patients with a history of one previous lower segment caesarean section were also included. Post date pregnancy and diabetes were the most common indications for induction.
There were significant differences in the two groups regarding the number of doses and the mean total dose of PGE2 used. The need for syntocinon augmentation was more in the nulliparae (41% vs 22%). Failed induction occurred only in nulliparae. The rate of caesarean section in induced labour remained significantly low compared with a spontaneous labour (11.6% vs 10.7%). The caesarean section rate was higher in the nulliparae (16.0% vs 9.6%) but this was not statistically significant. The caesarean section rate was higher when Bishop score 0-4 (76% vs 24%). Only two of the babies in the study group had an Apgar score less than 7 at 5 minutes. There was one caesarean hysterectomy because of postpartum hemorrhage associated with the PGE2 induction.
Conclusion: The calculated induction rate with PGE2 was 7% of total deliveries. Induction of labour with PGE2
in a grandmultiparae and previous caesarean section is relatively safe but further multicentre studies are needed to confirm our findings.
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Affiliation(s)
- M. Alsakka
- Department of Obstetrics and Gynecology Hamad Medical Corporation, Doha, Qatar
| | - W. Dauleh
- Department of Obstetrics and Gynecology Hamad Medical Corporation, Doha, Qatar
| | - H. Tamimi
- Department of Obstetrics and Gynecology Hamad Medical Corporation, Doha, Qatar
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Sobande AA, Al-Sunaidi MI, Al-Ghamdi JM, Archibong EI. Fundal hiatus discovered in a presumably unscarred uterus at emergency cesarean: an old perforation or rupture? Acta Obstet Gynecol Scand 2002; 81:673-5. [PMID: 12190843 DOI: 10.1034/j.1600-0412.2002.810714.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Adekunle A Sobande
- College of Medicine and Medical Sciences, King Khalid University and Abha Maternity Hospital, Abha, Saudi Arabia.
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Affiliation(s)
- C G Kobelin
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Edwards RK, Ripley DL, Davis JD, Bennett BB, Simms-Cendan JS, Cendan JC, Stone IK. Surgery in the pregnant patient. Curr Probl Surg 2001; 38:213-90. [PMID: 11296493 DOI: 10.1067/msg.2001.112768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- R K Edwards
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA
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Affiliation(s)
- D A Wing
- University of Southern California School of Medicine, Los Angeles, USA
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Abstract
OBJECTIVES To review the incidence of ruptured uteri at the Women's Hospital, Hamad Medical Corporation (HMC) and to analyze the causative factors of uterine rupture with a view to its prevention and to highlight the management approach taken to preserve the patient's reproductive potential. METHODS Case notes were reviewed for all patients (except for eight which were not available) with a ruptured uterus at the Women's Hospital in Doha for a period of 21 years from 1 July 1977 to 30 June 1997, relevant data relating to the clinical features characteristics of labor, operative procedures, and maternal perinatal outcome were assessed. RESULTS There were 31 cases of ruptured uteri. The incidence of ruptured uteri was calculated to be 0.017%, 23 cases being available for the study. Ten cases (43.5%) occurred in patients with previous cesarean scars, while 13 cases (56.5%) were grand multiparous (para 5 or more). In 10 cases (43.5%) uterine rupture was associated with oxytocin use, and four cases (18.2%) were associated with PGE2 use. The ruptures occurred in the lower segment of 19 cases (90.9%). Fetal heart abnormalities were observed in all cases except one in which the uterus ruptured during labor. Abdominal hysterectomy was performed in 15 cases (65.2%). The remaining eight patients had suture repair, two of them had suture repair with sterilization and the other six cases (26.1%) had suture repair without sterilization. Five of them became pregnant and were delivered by cesarean section. CONCLUSIONS Even though rupture of the uterus was rare in our study, its occurrence should be suspected when there are sudden fetal heart abnormalities during labor or unexpected postpartum shock. Suture repair should be considered whenever possible in order to maintain the patient's future fertility.
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Affiliation(s)
- M Al Sakka
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar.
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Roberts M, Nordin AJ. Posterior uterine rupture in a patient with a lower segment caesarean section scar complicating prostaglandin induction of labour. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:1421. [PMID: 9422029 DOI: 10.1111/j.1471-0528.1997.tb11021.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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