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Faraj C, Chait F, Elharras Y, Allali N, El Haddad S, Chat L. A rare case of uterine rupture in the first trimester of pregnancy: Case report and review of literature. Radiol Case Rep 2024; 19:2202-2205. [PMID: 38515767 PMCID: PMC10955100 DOI: 10.1016/j.radcr.2024.02.055] [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: 12/24/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024] Open
Abstract
Uterine rupture is a serious and potentially life-threatening complication. It is commonly a complication that happens in the third trimester of pregnancy. Its occurrence in early pregnancy is very rare. We report a case of a patient who presented with uterine rupture on a scarred uterus during the termination of pregnancy with misoprostol at 10 weeks' amenorrhea. In this case, we discuss the clinical warning signs, risk factors, and diagnostic methodology, and compare our approach with the literature.
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Affiliation(s)
- Chaymae Faraj
- Pediatric and Gynecology Radiology Department, Children's Hospital, Mohammed V University, Rabat, Morocco
| | - Fatima Chait
- Pediatric and Gynecology Radiology Department, Children's Hospital, Mohammed V University, Rabat, Morocco
| | - Yahya Elharras
- Pediatric and Gynecology Radiology Department, Children's Hospital, Mohammed V University, Rabat, Morocco
| | - Nazik Allali
- Pediatric and Gynecology Radiology Department, Children's Hospital, Mohammed V University, Rabat, Morocco
| | - Siham El Haddad
- Pediatric and Gynecology Radiology Department, Children's Hospital, Mohammed V University, Rabat, Morocco
| | - Latifa Chat
- Pediatric and Gynecology Radiology Department, Children's Hospital, Mohammed V University, Rabat, Morocco
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2
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Farhat IB, Zoukar O, Medemagh M, Slamia WB, Mnajja A, Bergaoui H, Hajji A, Gara M, Toumi D, Faleh R. [Retrospective study of 60 cases of uterine rupture at the Maternity Center of Monastir, Tunisia]. Pan Afr Med J 2024; 47:83. [PMID: 38737224 PMCID: PMC11087285 DOI: 10.11604/pamj.2024.47.83.42188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/11/2023] [Indexed: 05/14/2024] Open
Abstract
Uterine rupture is a life-threatening obstetric complication. The purpose of this study was to investigate the epidemiological features, maternal and foetal prognosis and different treatment options for uterine rupture in healthy and scarred uteri. We conducted a retrospective monocentric descriptive and analytical study of 60 cases of uterine rupture collected in the Department of Gynaecology-Obstetrics of the Center of Maternity and Neonatology, Monastir, from 2017 to 2021. Patients were classified according to the presence or absence of a uterine scar. Sixty patients were enrolled in the study. The majority of cases of rupture occurred in patients with scarred uterus (n=55). The most common clinical sign was abnormal foetal heart rate. No maternal deaths were recorded and perinatal mortality rate was 11%. Mean BMI, fetal macrosomia rate and mean parity were significantly higher in the healthy uterus group than in the scarred uterus group (p=0.033, 0.018, and 0.013, respectively). The maternal complications studied (post-partum haemorrhage, hysterectomy, blood transfusion, prolonged hospitalisation) were significantly more frequent in patients with unscarred uterine rupture (p=0.039; p=0.032; p=0.009; p=0.025 respectively). Uterine rupture is a life-threatening obstetrical event for the foetus and the mother. Fetal heart rate abnormality is the most common sign associated with uterine rupture. Management is based on conservative treatment in most cases. Patients with scarred uterus have a better prognosis.
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Affiliation(s)
- Imen Ben Farhat
- Université de Monastir, Faculté de Médecine de Monastir, Monastir, Tunisie
- Service de Gynécologie Obstétrique du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
| | - Olfa Zoukar
- Service de Gynécologie Obstétrique du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
| | - Malak Medemagh
- Service de Gynécologie Obstétrique du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
| | - Wiem Ben Slamia
- Service de Gynécologie Obstétrique du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
| | - Amina Mnajja
- Service de Gynécologie Obstétrique du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
| | - Haifa Bergaoui
- Université de Monastir, Faculté de Médecine de Monastir, Monastir, Tunisie
| | - Ahmed Hajji
- Service de Gynécologie Obstétrique du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
| | - Mouna Gara
- Service d'Anesthésie Réanimation du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
| | - Dhekra Toumi
- Service de Gynécologie Obstétrique du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
| | - Raja Faleh
- Service de Gynécologie Obstétrique du Centre de Maternité et de Néonatologie de Monastir, Monastir, Tunisie
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3
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Liao YC, Tsang LLC, Yang TH, Lin YJ, Chang YW, Hsu TY, Kung FT. Unscarred uterine rupture with catastrophic hemorrhage immediately after vaginal delivery: diagnosis and management of six consecutive cases. J Matern Fetal Neonatal Med 2023; 36:2243366. [PMID: 37586890 DOI: 10.1080/14767058.2023.2243366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND To describe and explore the risk factors, clinical presentations, timely diagnostic approaches, and management in patients experiencing unscarred uterine rupture with catastrophic hemorrhage. METHODS We retrospectively analyzed clinical and imaging data from women who encountered postpartum hemorrhage (PPH) and were diagnosed with unscarred uterine rupture within a three-year timeframe (2018-2020). The data were extracted from medical records obtained from a multi-hospital 24-hour emergency PPH transfer system. RESULTS Six patients were identified as having unscarred uterine rupture after vaginal delivery. All six women were para 2, with four of them undergoing vacuum-assisted delivery. One patient experienced out-of-hospital cardiac arrest (OHCA), while five patients presented with hypovolemic shock. Abdominopelvic ultrasound revealed a boggy lower uterine segment. Initially, five patients underwent transarterial embolization (TAE) of the internal iliac arteries in an attempt to achieve hemostasis, but this approach proved unsuccessful. Abdominopelvic computed tomography (CT) confirmed the diagnosis of ruptured uterus by demonstrating disrupted myometrium and hemoperitoneum. Immediate exploratory laparotomy followed by life-saving hysterectomy was performed in all cases. The median estimated total blood loss was 2725 mL ± 900 mL (ranging from 1600 mL to 7100 mL). Lower segment lacerations were observed in all patients, with more extensive uterine damage noted in those who underwent vacuum extraction. The length of hospital stay varied between 9 and 38 days. CONCLUSION Instrument-assisted obstetric delivery is a possible contributing factor to unscarred uterine rupture in our study. In specific cases, the use of abdominopelvic CT prior to initiating transarterial embolization (TAE) offers valuable information to complement ultrasound findings. This comprehensive approach helps in accurately identifying the underlying cause of intractable postpartum hemorrhage (PPH). Immediate conversion to laparotomy is essential to explore the intra-abdominal factors causing PPH that cannot be controlled by TAE. The rational etiologies of uterine rupture must be clarified while generating practical guideline in the future.
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Affiliation(s)
- Yi-Chiao Liao
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Leo Leung-Chit Tsang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsai-Hwa Yang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Wei Chang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Te-Yao Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
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Agarwal M, Singh S, Sinha S. A Rare and Unique Case Report of Lateral Uterine Wall Rupture and Its Review. Cureus 2023; 15:e38695. [PMID: 37292576 PMCID: PMC10245196 DOI: 10.7759/cureus.38695] [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] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Rupture of the uterus is a deadly obstetric complication. Its occurrence is uncommon and much less common in the second trimester. Given that the mother and fetus are in danger, it is a catastrophe for both. The incidence has increased in recent years as the cesarean section rate has increased, but in developing nations, multiparity and the inappropriate use of uterotonics are more common. This potentially disastrous event may have a vague initial presentation. Here forth, we present a case with solitary right lateral wall uterine rupture covering the entire length of the uterus, the fetus and placenta enclosed in between the broad ligament leaves, most likely due to injudicious misoprostol use at a private health care center superimposed on multiparity, and a literature review. As far as we know, this is the first instance of an isolated right lateral uterine wall rupture sparing the lower segment and, with the fetus trapped between the broad ligaments simulating abdominal pregnancy.
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Affiliation(s)
- Mukta Agarwal
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, IND
| | - Smita Singh
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Patna, IND
| | - Shivangni Sinha
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, IND
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5
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Belmajdoub M, Alaoui FZF, Chaara H, Melhouf A. [Uterine rupture in patients with healthy uterus: misoprostol complication (case study and literature review)]. Pan Afr Med J 2018; 31:223. [PMID: 31447981 PMCID: PMC6691284 DOI: 10.11604/pamj.2018.31.223.12906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/08/2018] [Indexed: 11/18/2022] Open
Abstract
La rupture utérine sur utérus sain au 2ème et 3ème trimestre de grossesse est une complication obstétricale rare et grave mettant en jeu les pronostics vitaux maternels et fœtaux et le devenir obstétrical des patientes en l'absence de diagnostic et de prise en charge immédiate. Elle survient majoritairement sur un utérus cicatriciel et reste anecdotique sur un utérus sain. Nous rapportons le cas d'une patiente primigeste ayant présenté une rupture utérine sur un utérus non cicatriciel lors d'un déclenchement de travail par le misoprostol pour mort fœtale in utero (MFIU) sur retard de croissance intra utérin (RCIU) et oligoamnios sévère à 31 semaines d'aménorrhée (SA). Nous discutons à travers ce cas et la revue de la littérature, l'extrême prudence qu'il faut garder pour utiliser le misoprostol en cas de déclenchement du travail ainsi que les signes d'appel cliniques, les facteurs de risque, la méthodologie diagnostique et la prise en charge thérapeutique de cette entité rare mais potentiellement grave.
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Affiliation(s)
- Meryem Belmajdoub
- Centre Hospitalier Hassan II, Service de Gynécologie et Obstétrique 2, Fès, Maroc
| | | | - Hikmat Chaara
- Centre Hospitalier Hassan II, Service de Gynécologie et Obstétrique 2, Fès, Maroc
| | - Abdelilah Melhouf
- Centre Hospitalier Hassan II, Service de Gynécologie et Obstétrique 2, Fès, Maroc
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Sun X, Xu J, Liu Y, Teng X, Wang L. Herniation of the amniotic sac through congenital uterine defect confirmed during operation: A case report. J Obstet Gynaecol Res 2018; 45:450-453. [PMID: 30288859 DOI: 10.1111/jog.13834] [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: 04/16/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
Abstract
Herniation of the amniotic sac into the peritoneal cavity or bladder is a rare but serious condition during pregnancy, which has not been reported in pored congenital uterine anomaly. Here, we report a rare case to draw obstetricians' attention to the atypical uterine rupture. A primigravida at 35 weeks of gestation was admitted for upper abdominal pain. A primary diagnosis of uterine rupture was made after finding the amniotic sac herniation through obstetric ultrasound. Exploration during emergent cesarean section revealed symmetrical pored defect on the uterine horn. The diagnosis of uterine anomaly was eventually made. The educational meaning of this rare case is that it is advisable to rule out uterine anomalies when signs of uterine rupture are suspected during pregnancy while contributory risk factors have not been identified. Besides, it is of vital importance to make a full assessment of both the mother and the fetus so to determine the appropriate time of termination.
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Affiliation(s)
- Xiwen Sun
- Department of Obstetrics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingwei Xu
- Department of Obstetrics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuanyuan Liu
- Department of Obstetrics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyuan Teng
- Department of Obstetrics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liquan Wang
- Department of Obstetrics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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7
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Bhoil R, Surya M, Mistry KA. CT diagnosis of spontaneous uterine rupture at term, sonographic appearance of which was confused with placenta praevia. Ann Saudi Med 2016; 36:440-441. [PMID: 27920419 PMCID: PMC6074206 DOI: 10.5144/0256-4947.2016.440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rohit Bhoil
- Dr. Rohit Bhoil, Department of Radiodiagnosis,, Dr. RPGMC Kangra, India, T: +91-9418021905, , ORCID: http://orcid.org/0000-0002-5155-8325
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8
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Suleiman MB, Mokuolu OA. Perinatal Mortality in a Northwestern Nigerian City: A Wake up Call. Front Pediatr 2014; 2:105. [PMID: 25340044 PMCID: PMC4189423 DOI: 10.3389/fped.2014.00105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/14/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Nigeria, of the over 900,000 children under the age of 5 years that die every year, perinatal mortality is responsible for a little over 20%. Previous reports are largely from the southern part of the country. This is the first report of perinatal data from the northwest of Nigeria. METHODS A case control study of perinatal deaths in the three major public hospitals in Katsina metropolis was carried out to determine the pattern of perinatal deaths in the metropolis. Data were collected over a 6 week period on maternal socio-demographic, antenatal, and delivery variables. Data were similarly obtained on neonatal profile and morbidities. RESULTS There were 143 perinatal deaths (94 stillbirths and 49 early neonatal deaths) out of 1104 live and stillbirths during the study period. The perinatal mortality rate was thus 130 per 1000 births with a stillbirth rate of 85 per 1000 births and an early neonatal mortality rate of 49 per 1000 live births. Stillbirths during the intrapartum period were twice as frequent as macerated stillbirths (2:1). Maternal factors significantly associated with perinatal deaths included chorioamnionitis, ruptured uterus, multiple gestation, medically induced delivery, prolonged labor, unbooked pregnancies, antepartum hemorrhage, and prolonged rupture of membranes. Antepartum hemorrhage was the strongest determinant of perinatal death. Significant neonatal determinants were multiple gestation, severe birth asphyxia, apnea, and necrotizing enterocolitis. Apnea was the strongest neonatal determinant. The majority (83.2%) of perinatal deaths were due to severe perinatal asphyxia (SPA) (54.5%), normally formed macerated stillbirths (20.3%), and immaturity (8.4%). CONCLUSION In conclusion, Perinatal Mortality in Katsina metropolis in northwest Nigeria is unacceptably high as we approach the timeline for the millennium development goals. Antepartum hemorrhage and SPA are major determinants.
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Affiliation(s)
| | - Olugbenga Ayodeji Mokuolu
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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9
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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: 45] [Impact Index Per Article: 4.5] [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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10
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Mishina M, Hasegawa J, Ichizuka K, Oba T, Sekizawa A, Okai T. Defect in the uterine wall with prolapse of amniotic sac into it at 32 weeks' gestation in a primigravida woman without any previous uterine surgery. J Obstet Gynaecol Res 2013; 40:840-2. [DOI: 10.1111/jog.12214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Miyuki Mishina
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo Japan
| | - Tomohiro Oba
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo Japan
| | - Takashi Okai
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo Japan
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11
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Rupture utérine spontanée de découverte tardive sur utérus sain après utilisation du misoprostol. IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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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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13
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Hagneré P, Denoual I, Souissi A, Deswarte S. Rupture utérine spontanée après myomectomie. À propos d’un cas et revue de la littérature. ACTA ACUST UNITED AC 2011; 40:162-5. [DOI: 10.1016/j.jgyn.2010.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 08/05/2010] [Accepted: 08/17/2010] [Indexed: 11/30/2022]
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14
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Rupture of intrapartum unscarred uterus at the fundus: a complication of passive cocaine abuse? Arch Gynecol Obstet 2011; 283 Suppl 1:53-4. [DOI: 10.1007/s00404-011-1853-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
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15
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Dane B, Dane C. Maternal Death After Uterine Rupture in an Unscarred Uterus: A Case Report. J Emerg Med 2009; 37:393-5. [DOI: 10.1016/j.jemermed.2007.10.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 03/12/2007] [Accepted: 10/28/2007] [Indexed: 11/30/2022]
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16
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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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17
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Fatfouta I, Villeroy de Galhau S, Dietsch J, Eicher E, Perrin D. [Spontaneous uterine rupture of an unscarred uterus during labor: case report and review of the literature]. ACTA ACUST UNITED AC 2007; 37:200-3. [PMID: 17997233 DOI: 10.1016/j.jgyn.2007.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 07/13/2007] [Accepted: 09/12/2007] [Indexed: 10/22/2022]
Abstract
Uterine rupture during labor is a serious and uncommon obstetrical complication that can lead to severe prognosis for the mother and her child if not immediately diagnosed and treated. Most spontaneous uterine ruptures occur during labor in parturients with a scarred uterus and are much rarer on an unscarred uterus. We report the case of a uterine rupture on unscarred uterus to a 32 year-old woman after a labor induced by intravaginal prostaglandin and intravenous ocytocine injection. Our management is compared with the data from literature.
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Affiliation(s)
- I Fatfouta
- Service de gynécologie-obstétrique, centre hospitalier François-Maillot, 31, avenue Albert-de-Briey, 54150 Briey, France.
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Abstract
UNLABELLED Uterine rupture is a catastrophic obstetric complication, associated with high rates of perinatal morbidity and mortality. The most common risk factor is previous uterine surgery, and most cases of uterine rupture occur in women with a previous cesarean delivery. Traditionally, the primigravid uterus has been considered almost immune to spontaneous rupture. In fact, although spontaneous rupture of the primigravid uterus is indeed a very rare event, a number of such cases have been reported recently. Prompt recognition of uterine rupture and expeditious recourse to laparotomy are critical in influencing perinatal and maternal morbidity. Not all uterine ruptures present with the typical clinical picture of abdominal pain, hypovolemia, vaginal bleeding, and fetal compromise. Therefore, it is important to maintain a high index of suspicion for uterine rupture in women presenting with some, or all, of these features, regardless of parity. Here we provide a systematic review of cases of spontaneous uterine rupture in primigravid women reported in the literature to date. Clinical presentation, differential diagnosis, common etiological factors, complication rates, and appropriate management of this rare obstetric event are discussed. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to recall that uterine rupture in a primigravida is a rare event, without typical signs and symptoms, and explain that the morbidity and mortality of the mother and child is directly related to a high index of suspicion and prompt treatment by the clinician.
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Affiliation(s)
- Colin A Walsh
- Department of Obstetrics and Gynecology, Sloane Hospital for Women, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York 10032, USA
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