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Overtoom EM, Huynh TN, Rosman AN, Zwart JJ, Schaap TP, Vogelvang TE, van den Akker T, Bloemenkamp KWM. Predicting the risks and recognizing the signs: a two-year prospective population-based study on pregnant women with uterine rupture in The Netherlands. J Matern Fetal Neonatal Med 2024; 37:2311083. [PMID: 38350236 DOI: 10.1080/14767058.2024.2311083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To estimate the incidence of uterine rupture in the Netherlands and evaluate risk indicators prelabour and during labor of women with adverse maternal and/or perinatal outcome. METHODS This is a population-based nationwide study using the Netherlands Obstetrics Surveillance System (NethOSS). We performed a two-year registration of pregnant women with uterine rupture. The first year of registration included both women with complete uterine rupture and women with incomplete (peritoneum intact) uterine rupture. The second year of registration included women with uterine rupture with adverse maternal and/or perinatal outcome. We collected maternal and obstetric characteristics, clinical signs, and symptoms during labor and CTG abnormalities. The main outcome measures were incidence of complete uterine rupture and uterine rupture with adverse outcome and adverse outcome defined as major obstetric hemorrhage, hysterectomy, embolization, perinatal asphyxia and/or (neonatal) intensive care unit admission. RESULTS We registered 41 women with a complete uterine rupture (incidence: 2.5 per 10,000 births) and 35 women with uterine rupture with adverse outcome (incidence: 0.9 per 10,000 births). No adverse outcomes were found among women with incomplete uterine rupture. Risk indicators for adverse outcome included previous cesarean section, higher maternal age, gestational age <37 weeks, augmentation of labor, migration background from Sub-Saharan Africa or Asia. Compared to women with uterine rupture without adverse outcomes, women with adverse outcome more often expressed warning symptoms during labor such as abdominal pain (OR 3.34, 95%CI 1.26-8.90) and CTG abnormalities (OR 9.94, 95%CI 2.17-45.65). These symptoms were present most often 20 to 60 min prior to birth. CONCLUSION Uterine rupture is a rare condition for which several risk indicators were identified. Maternal symptoms and CTG abnormalities are associated with adverse outcomes and time dependent. Further analysis could provide guidance to expedite delivery.
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Affiliation(s)
- E M Overtoom
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - T N Huynh
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - J J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - T P Schaap
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - T van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
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Wetzler S, Cabrera C, Bernstein PS. Spontaneous uterine rupture complicated by bilateral pulmonary emboli: A case report. Case Rep Womens Health 2024; 42:e00608. [PMID: 38633224 PMCID: PMC11021356 DOI: 10.1016/j.crwh.2024.e00608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Spontaneous uterine rupture in unscarred uteri complicated by pulmonary emboli is a rare event with major maternal morbidity and mortality. This is a case of a 32-year-old woman, G1P0, at term, with no pertinent past medical/surgical history, who underwent an emergency cesarean delivery for failed induction of labor complicated by uterine rupture. Post-operatively, the patient was tachycardic and hypoxic. CT arteriogram revealed massive bilateral pulmonary emboli, and she was transferred for specialist care. An emergency pulmonary embolectomy and implantation of an extracorporeal right ventricular assist device were performed. Once the patient was clinically stable, an evaluation for thrombophilias and collagen disorders was done, and was positive for a variant of unknown significance in the ELN gene (c.205G > C). This case report highlights a potential connection between uterine ruptures, hemorrhage, and multiple, large pulmonary emboli. The authors propose a multidisciplinary discussion and evaluation to identify risk factors and biologic causes for these rare but life-threatening complications.
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Affiliation(s)
- Sara Wetzler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Camila Cabrera
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Peter S. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Azouz I, Souissi B, Ayadi M, Hakim H, Gassara H, Talbi S, Mahfoudh KB. Traumatic uterine rupture: A rare complication of vehicle accidents. Radiol Case Rep 2024; 19:1994-1997. [PMID: 38440740 PMCID: PMC10909957 DOI: 10.1016/j.radcr.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
The rupture of the gravid uterus is a rare complication of trauma. It is reported in less than one percent of pregnant women who are victims of road accidents. The authors report the case of a 26-year-old nulliparous patient presented with a uterine rupture resulting in fetal death at 32 weeks of gestation following a nonpenetrating abdominal trauma in a road traffic accident. An extreme emergency operation and abdominal laparotomy confirmed the imaging findings and led to conservative treatment of the uterus and a splenectomy.
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Affiliation(s)
- Ines Azouz
- Department of Radiology, Hbib Bourguiba university hospital, Faculty of medicine of Sfax, Tunsia
| | - Basma Souissi
- Department of Radiology, Hbib Bourguiba university hospital, Faculty of medicine of Sfax, Tunsia
| | - Malek Ayadi
- Department of Radiology, Hbib Bourguiba university hospital, Faculty of medicine of Sfax, Tunsia
| | - Hana Hakim
- Departement of Gynecology and obstetrics, Hedi Chaker university hospital, Faculty of medicine of Sfax, Tunsia
| | - Hichem Gassara
- Departement of Gynecology and obstetrics, Hedi Chaker university hospital, Faculty of medicine of Sfax, Tunsia
| | - Skander Talbi
- Department of general surgery, Hbib Bourguiba university hospital, Faculty of medicine of Sfax, Tunsia
| | - Khaireddine Ben Mahfoudh
- Department of Radiology, Hbib Bourguiba university hospital, Faculty of medicine of Sfax, Tunsia
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5
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Amikam U, Hochberg A, Abramov S, Lavie A, Yogev Y, Hiersch L. Risk factors for maternal complications following uterine rupture: a 12-year single-center experience. Arch Gynecol Obstet 2024; 309:1863-1871. [PMID: 37149828 DOI: 10.1007/s00404-023-07061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To determine maternal outcomes and risk factors for composite maternal morbidity following uterine rupture during pregnancy. METHODS A retrospective cohort study including all women diagnosed with uterine rupture during pregnancy, between 2011 and 2023, at a single-center. Patients with partial uterine rupture or dehiscence were excluded. We compared women who had composite maternal morbidity following uterine rupture to those without. Composite maternal morbidity was defined as any of the following: maternal death; hysterectomy; severe postpartum hemorrhage; disseminated intravascular coagulation; injury to adjacent organs; admission to the intensive care unit; or the need for relaparotomy. The primary outcome was risk factors associated with composite maternal morbidity following uterine rupture. The secondary outcome was the incidence of maternal and neonatal complications following uterine rupture. RESULTS During the study period, 147,037 women delivered. Of them, 120 were diagnosed with uterine rupture. Among these, 44 (36.7%) had composite maternal morbidity. There were no cases of maternal death and two cases of neonatal death (1.7%); packed cell transfusion was the major contributor to maternal morbidity [occurring in 36 patients (30%)]. Patients with composite maternal morbidity, compared to those without, were characterized by: increased maternal age (34.7 vs. 32.8 years, p = 0.03); lower gestational age at delivery (35 + 5 vs. 38 + 1 weeks, p = 0.01); a higher rate of unscarred uteri (22.7% vs. 2.6%, p < 0.01); and rupture occurring outside the lower uterine segment (52.3% vs. 10.5%, p < 0.01). CONCLUSION Uterine rupture entails increased risk for several adverse maternal outcomes, though possibly more favorable than previously described. Numerous risk factors for composite maternal morbidity following rupture exist and should be carefully assessed in these patients.
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Affiliation(s)
- Uri Amikam
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alyssa Hochberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tiqva, Israel
| | - Shani Abramov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Kotsuji F, Shibata T, Nakago S, Kato H, Hosono S, Fukuoka Y, Nishijima K. Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study. BMC Pregnancy Childbirth 2024; 24:277. [PMID: 38622521 PMCID: PMC11017641 DOI: 10.1186/s12884-024-06446-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Transverse uterine fundal incision (TUFI) is a beneficial procedure for mothers and babies at risk due to placenta previa-accreta, and has been implemented worldwide. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. We therefore evaluated the TUFI wound scar to determine the approval criteria for pregnancy after this surgery. METHODS Between April 2012 and August 2022, we performed TUFI on 150 women. Among 132 of the 150 women whose uteruses were preserved after TUFI, 84 women wished to conceive again. The wound healing status, scar thickness, and resumption of blood flow were evaluated in these women by magnetic resonance imaging (MRI) and sonohysterogram at 12 months postoperatively. Furthermore, TUFI scars were directly observed during the Cesarean sections in women who subsequently conceived. RESULTS Twelve women were lost to follow-up and one conceived before the evaluation, therefore 71 cases were analyzed. MRI scans revealed that the "scar thickness", the thinnest part of the scar compared with the normal surrounding area, was ≥ 50% in all cases. The TUFI scars were enhanced in dynamic contrast-enhanced MRI except for four women. However, the scar thickness in these four patients was greater than 80%. Twenty-three of the 71 women conceived after TUFI and delivered live babies without notable problems until August 2022. Their MRI scans before pregnancy revealed scar thicknesses of 50-69% in two cases and ≥ 70% in the remaining 21 cases. And resumption of blood flow was confirmed in all patients except two cases whose scar thickness ≥ 90%. No evidence of scar healing failure was detected at subsequent Cesarean sections, but partial thinning was found in two patients whose scar thicknesses were 50-69%. In one woman who conceived seven months after TUFI and before the evaluation, uterine rupture occurred at 26 weeks of gestation. CONCLUSIONS Certain criteria, including an appropriate suture method, delayed conception for at least 12 months, evaluation of the TUFI scar at 12 months postoperatively, and cautious postoperative management, must all be met in order to approve a post-TUFI pregnancy. Possible scar condition criteria for permitting a subsequent pregnancy could include the scar thickness being ≥ 70% of the surrounding area on MRI scans, at least partially resumed blood flow, and no abnormalities on the sonohysterogram. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Fumikazu Kotsuji
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
| | - Takashi Shibata
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
| | - Satoshi Nakago
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
| | - Hiroki Kato
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
| | - Sayoko Hosono
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
| | - Yasunori Fukuoka
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Nishijima
- Center for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
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7
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Verspyck E, Morau E, Chiesa-Dubruille C, Bonnin M. [Maternal mortality due to obstetric haemorrhage in France 2016-2018]. Gynecol Obstet Fertil Senol 2024; 52:238-245. [PMID: 38373487 DOI: 10.1016/j.gofs.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
Between 2016 and 2018, 20 maternal deaths were related to obstetric haemorrhage, excluding haemorrhage in the first trimester of pregnancy, representing a mortality ratio of 0.87 per 100,000 live births (95% CI 0.5 -1.3). Obstetric haemorrhage is the cause of 7.4% of all maternal deaths up to 1 year, 10% of maternal deaths within 42days, and 21% of deaths directly related to pregnancy (direct causes). Between 2001 and 2018, maternal mortality from obstetric haemorrhage has been considerably reduced, from 2.2deaths per 100,000 live births in 2001-2003 to 0.87 in the period presented here. Nevertheless, obstetric haemorrhage is still one of the main direct causes of maternal death, and remains the cause with the highest proportion of deaths considered probably (53%) or possibly (42%) preventable according to the CNEMM's collegial assessment (see chapter 3). The preventable factors reported are related to inadequate content of care in 94% of cases and/or organisation of care in 44% of cases. In this triennium, maternal death due to haemorrhage occurred mainly in the context of caesarean delivery (65% of cases, i.e. 13/20), and mostly in the context of emergency care (12/13). The main causes of obstetric haemorrhage were uterine rupture (6/20) in unscarred uterus or in association with placenta accreta, and surgical injury during the caesarean delivery (5/20). Every maternity hospital, whatever its resources and/or technical facilities, must be able to plan any obstetric haemorrhage situation that threatens the mother's vital prognosis. Intraperitoneal occult haemorrhage following caesarean section and uterine rupture require immediate surgery with the help of skilled surgeon resources with early and appropriate administration of blood products.
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Affiliation(s)
- Eric Verspyck
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
| | - Estelle Morau
- Service d'anesthésie-réanimation, CHU de Nîmes, Nîmes, France
| | - Coralie Chiesa-Dubruille
- Département de Maïeutique, Paris Saclay, UFR Simone Veil-Santé, université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; Service de gynécologie-obstétrique, centre hospitalier de Rambouillet, Rambouillet, France
| | - Martine Bonnin
- Pôle femme et enfant, hôpital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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8
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Rozenberg P. [Usefulness of ultrasound measurement of the lower uterine segment before delivery of women with a prior cesarean: Literature review]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00090-4. [PMID: 38521126 DOI: 10.1016/j.gofs.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Identifying women with a history of cesarean delivery and at real risk for uterine rupture is an important aim in obstetric care. It is with this objective that different authors have evaluated the interest of ultrasound for predicting the risk of a cesarean scar defect by measuring the thickness of the lower uterine segment. The literature is sparse and subject to numerous biases because they are mainly prospective cohort studies with small numbers. However, the results are concordant: Ultrasound measurements of lower uterine segment thickness are strongly correlated with the operative findings observed during cesarean delivery. Moreover, the thinner the lower uterine segment on ultrasound, the higher the likelihood of a uterine defect. Two randomized trials have recently been published. The PRISMA cluster randomized controlled trial evaluated a multifaceted intervention including an ultrasound estimation of the risk of uterine rupture by ultrasound measurement of the lower uterine segment thickness and aimed at helping women in their choice of mode of delivery after a previous cesarean delivery. This multifaceted intervention resulted in a significant reduction in the rates of major perinatal and maternal morbidity, without any increase in the rate of cesarean delivery or uterine rupture. However, due to its design, it is impossible to specifically specify the benefit of lower uterine segment measurement in reducing major maternal and perinatal morbidity since the trial combined several interventions. The LUSTrial randomized controlled trial evaluated the impact on maternal-fetal morbidity and mortality of proposing a mode of delivery based on ultrasound measurement of the lower uterine segment thickness compared to usual care among women with a history of cesarean delivery. Ultrasound measurement of lower uterine segment thickness was not associated with a statistically significant reduction in maternal-fetal morbidity and mortality compared to usual care. In this literature review, we will mainly detail and analyze the results of this trial.
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Affiliation(s)
- Patrick Rozenberg
- Service d'obstétrique et gynécologie, hôpital américain de Paris, 92200 Neuilly-sur-Seine, France; Équipe U1018, épidémiologie clinique, CESP, université Paris Saclay, UVSQ, Inserm, 78180 Montigny-le-Bretonneux, France.
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9
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Vinken J, Emslie E, Smith S. Spontaneous Uterine Artery Rupture in a Nongravid Patient. J Minim Invasive Gynecol 2024:S1553-4650(24)00109-2. [PMID: 38460866 DOI: 10.1016/j.jmig.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Jamie Vinken
- Department of Obstetrics and Gynecology, College of Medicine, University of Saskatchewan, 7344 6th Ave, Regina SK, S4T 0P2.
| | - Ethan Emslie
- Department of Obstetrics and Gynecology, College of Medicine, University of Saskatchewan, 302-2300 Broad Street, Regina, SK, S4P 1Y8.
| | - Sarah Smith
- Department of Obstetrics and Gynecology, College of Medicine, University of Saskatchewan, 606 Victoria Avenue Regina, SK.
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10
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Isikhuemen ME, Imarengiaye CA, Oyelade TA, Okonofua FE. Spontaneous second trimester rupture of a previous caesarean section scar: A case report. Afr J Reprod Health 2024; 28:125-128. [PMID: 38426295 DOI: 10.29063/ajrh2024/v28i2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Spontaneous uterine rupture before the onset of labour is rare in pregnancy especially before the third trimester. It is life threatening with devastating consequences to the mother and fetus. We report a case of spontaneous second trimester uterine rupture in a multipara with a previous uterine scar with the aim of creating awareness and sharing the challenges in diagnosis and management of this unusual complication of pregnancy. A 34-year-old woman with two previous deliveries presented at 16 weeks gestation with abdominal pain and vaginal bleeding of one day duration. At presentation, she was pale and in shock. There was generalized abdominal tenderness with guarding and rebound tenderness. At laparotomy, there was uterine rupture involving the lower segment with right lateral upward extension which was repaired. She remained stable at the follow up visit. In conclusion, Spontaneous uterine rupture of a previous caesarean section scar in the second trimester is rare. The diagnosis should be considered in a woman with previous caesarean section who experience an acute abdomen in the second trimester of pregnancy.
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Affiliation(s)
- Maradona E Isikhuemen
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Edo State, Nigeria
| | | | | | - Friday E Okonofua
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Edo State, Nigeria
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11
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Sutton OM, Berman DJ, Vaught AJ, Bradshaw JC, Johns RA. Diagnosis and management of a ruptured 20-week anencephalic cornual ectopic pregnancy undergoing termination: implications of interstate travel due to restrictive abortion law. Int J Obstet Anesth 2024; 57:103932. [PMID: 37891127 DOI: 10.1016/j.ijoa.2023.103932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/07/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
In the changing legal environment of obstetric care in the USA, with laws in many states banning termination at all stages of pregnancy with narrow exemptions, healthcare providers are encountering cases in which risk to maternal safety is increased. This report presents a case of a 28-year-old primigravida with an anencephalic fetus who was legally unable to pursue termination in her home state. She traveled to another state in order to pursue safe and legal abortion of a non-viable fetus. Due to an unrecognized cornual ectopic gestation, the delivery resulted in uterine rupture, the need for hysterectomy, and significant morbidity in a patient with a strong desire for future fertility.
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Affiliation(s)
- O M Sutton
- Department of Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - D J Berman
- Department of Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA
| | - A J Vaught
- Department of Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA
| | - J C Bradshaw
- Department of Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA
| | - R A Johns
- Department of Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA
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12
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Houri O, Romano A, Geron Y, Zeevi G, Hadar E, Barbash-Hazan S, Danieli-Gruber S. Outcome of subsequent pregnancies in women with prior uterine rupture. Eur J Obstet Gynecol Reprod Biol 2024; 292:97-101. [PMID: 37992425 DOI: 10.1016/j.ejogrb.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To report maternal and neonatal outcomes of subsequent pregnancies in a series of women with a prior uterine rupture. METHODS The records of all 103,542 deliveries (22,286 by cesarean section) performed in a single tertiary medical center from 2009 to 2021 were reviewed. Women with a prior uterine rupture, defined as a separation of the entire thickness of the uterine wall, with extrusion of fetal parts and intra-amniotic contents into the peritoneal cavity documented in the operative report of the previous cesarean delivery or laparotomy, were identified for inclusion in the study. RESULTS The cohort included 38 women with 50 pregnancies (50 neonates). Women had been scheduled for elective cesarean delivery at early term. Mean gestational age at delivery was 36 + 4 weeks (±5 days). In 7 pregnancies (14 %), spontaneous labor occurred before the scheduled cesarean delivery (at 36 + 6, 35 + 4, 35 + 3, 34 + 6, 34 + 3, 32 + 6 and 31 + 0 gestational weeks). A recurrent uterine scar rupture was found in 4 pregnancies (8 %), and uterine scar dehiscence, in 2 pregnancies (4 %), all identified during elective repeat cesarean delivery. In none of these cases was there a clinical suspicion beforehand; all had good maternal and neonatal outcomes. One parturient with placenta previa-accreta had a planned cesarean hysterectomy. CONCLUSION Women with prior uterine rupture have good maternal and neonatal outcomes in subsequent pregnancies when managed at a tertiary medical center, with planned elective term cesarean delivery, or even earlier, at the onset of spontaneous preterm labor.
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Affiliation(s)
- Ohad Houri
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Romano
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Geron
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Zeevi
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Barbash-Hazan
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Danieli-Gruber
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Ishikawa H, Saito Y, Koga K, Shozu M. Reproductive outcomes following abdominal repair for cesarean scar defect in women who desire subsequent pregnancies: A single-center retrospective study. Eur J Obstet Gynecol Reprod Biol 2023; 291:141-147. [PMID: 37871351 DOI: 10.1016/j.ejogrb.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To clarify the reproductive outcomes of women who underwent abdominal repair surgery for cesarean scar defect (CSD). STUDY DESIGN This is a retrospective observational study performed in a tertiary center. We retrospectively reviewed 20 women who underwent abdominal repair between 2007 and 2021. The indication for the repair was a minimal residual myometrial thickness (RMT) of ≦3.0 mm. We investigated surgical complications, changes in minimal RMT before and three-months after the repair, and reproductive outcomes. RESULTS The median age at the time of repair was 36 years (27-40), with a median body mass index of 21.0 (17.7-28.7) and a median of 1 prior cesarean section (1-5). Twelve women reported secondary infertility, while eight women were concerned about the potential risk of uterine rupture in future pregnancies due to thin RMT. Additionally, one woman had a co-existing vesicouterine fistula, two had abscess and hematoma formation at the precedent cesarean section, and three showed remarkable dehiscence of the defect. The median minimal RMT significantly increased to 5.05 mm (range; 2.5-14.2 mm) after the repair. Seven women had a total of eight live births, with a median duration from the repair to a live-birth pregnancy of 11.5 months (range; 4-20 months). No surgical complications occurred during the repair, and there were no instances of uterine rupture in subsequent pregnancies. However, one woman who became pregnant with twins following double blastocyst transfer required a cesarean section at 25 weeks of pregnancy due to bulging towards the bladder side of the repaired CSD. CONCLUSION Abdominal repair for CSD is feasible in women with thin RMT who experience secondary infertility. Twin pregnancies can promote thinning of the CSD repair site, potentially increasing the risk of uterine rupture.
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Affiliation(s)
- Hiroshi Ishikawa
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Yoshiko Saito
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kaori Koga
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan; Evolution and Reproductive Biology, Medical Mycology Research Center, Chiba University, Chiba, Japan
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Chambers M, Nguyen Pham A, Milone G, Licon E, Bakhta Y, Chan K. A case of traumatic uterine avulsion in pregnancy. Trauma Case Rep 2023; 47:100920. [PMID: 37705926 PMCID: PMC10495616 DOI: 10.1016/j.tcr.2023.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/15/2023] Open
Abstract
Complete uterine avulsion is an extremely rare complication of trauma sustained during pregnancy. We present the case of a 21-year-old nullipara at 16 weeks' gestation who was involved in a high-speed motor vehicle collision with subsequent fetal demise. Initially she was hemodynamically stable and demonstrated small amounts of intraabdominal free fluid, therefore multidisciplinary conservative measures were undertaken. However, as her condition worsened, she was taken for exploratory laparotomy, revealing complete gravid uterine avulsion at the level of the cervicoisthmic junction. Due to hemodynamic instability and concerns for retroperitoneal bleeding, a supracervical hysterectomy was performed. Although a rare occurrence, our case demonstrates the need for a high level of suspicion for uterine avulsion in certain cases of trauma in pregnancy. This highlights the false reassurance provided by stable vitals in a pregnant patient that may mask ongoing bleeding and development of hemorrhagic shock, the importance of interpreting different imaging modalities together when the cause of instability is unclear, and the utility of a multidisciplinary approach. While our patient underwent hysterectomy due to hemodynamic instability, it is unknown whether earlier investigation with laparoscopy to confirm uterine integrity may have circumvented this and allowed for fertility-sparing management. As such, our case encourages the utilization of early diagnostic laparoscopy if there is concern for uterine avulsion for the consideration of alternative surgical interventions for management.
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Affiliation(s)
- M.E. Chambers
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - A.B. Nguyen Pham
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - G.F. Milone
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - E. Licon
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - Y.A. Bakhta
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - K.K. Chan
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
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15
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Finnsdottir SK, Maghsoudlou P, Pepin K, Gu X, Carusi DA, Einarsson JI, Rassier SLC. Uterine rupture and factors associated with adverse outcomes. Arch Gynecol Obstet 2023; 308:1271-1278. [PMID: 36271922 DOI: 10.1007/s00404-022-06820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/08/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To review cases of uterine rupture and identify risk factors associated with adverse outcomes. METHODS This study is a retrospective cohort of complete uterine ruptures diagnosed in a large hospital system in Massachusetts between 2004 and 2018. Baseline demographics, labor characteristics and outcomes of uterine rupture were collected from medical records. RESULTS A total of 173 cases of uterine rupture were identified. There were 30 (17.3%) women with an unscarred uterus, while 142 (82.1%) had a scarred uterus. Adverse outcomes (n = 89, 51.4% of cases) included 26 (15.0%) hysterectomies, 55 (31.8%) blood transfusions, 18 (10.4%) bladder/ureteral injuries, 5 (2.9%) reoperations, 25 (14.5%) Apgar scores lower than 5 at 5 min and 9 (5.2%) perinatal deaths. Uterine rupture of a scarred uterus was associated with decreased risk of hemorrhage (OR 0.40, 95% CI 0.17-0.93), blood transfusion (OR 0.27, 95% CI 0.11-0.69), hysterectomy (OR 0.23, 95% CI 0.08-0.69) and any adverse outcome (OR 0.34, 95% CI 0.13-0.91) compared with unscarred rupture. Uterine rupture during vaginal delivery was associated with increased risk of transfusion (OR 6.55, 95% CI 1.53-28.05) and hysterectomy (OR 8.95, 95% CI 2.12-37.72) compared with emergent C-section. CONCLUSIONS Although rare, uterine rupture is associated with adverse outcomes in over half of cases. Unscarred rupture and vaginal delivery demonstrate increased risk of adverse outcomes, highlighting the need for early diagnosis and operative intervention.
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Affiliation(s)
- Stefania K Finnsdottir
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Parmida Maghsoudlou
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Kristen Pepin
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Xiangmei Gu
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Daniela A Carusi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, US
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Sarah L Cohen Rassier
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US.
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16
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Saleem HA, Edweidar Y, Salim MA, Mahfouz IA. Mid-trimester spontaneous rupture of a bicornuate uterus: A case report. Case Rep Womens Health 2023; 39:e00524. [PMID: 37954229 PMCID: PMC10636261 DOI: 10.1016/j.crwh.2023.e00524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 11/14/2023] Open
Abstract
Bicornuate uterus (BU) is a rare congenital anomaly that may present with various obstetric complications, and very rarely may be a risk factor for uterine rupture, even of an unscarred uterus. A 21-year-old primigravida woman, at 19 weeks and 5 days of gestation, presented with severe abdominal pain and features of hypovolemic shock. Urgent laparotomy showed a large hemoperitoneum, a ruptured left horn of a BU and a dead fetus in the abdominal cavity. Excision of the ruptured left horn was performed and the uterine defect was sutured. Postoperative recovery was uneventful. Bicornuate uterus is a rare uterine anomaly and is associated with various obstetric complications at different gestational ages. Ruptured uterus should be considered in the differential diagnoses of acute abdominal pain and a picture of hypovolemia in women with mid-trimester pregnancies.
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17
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Komatsu H, Taniguchi F, Harada T. Impact of adenomyosis on perinatal outcomes: a large cohort study (JSOG database). BMC Pregnancy Childbirth 2023; 23:579. [PMID: 37568120 PMCID: PMC10422787 DOI: 10.1186/s12884-023-05895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND A previous study investigated the effect of adenomyosis on perinatal outcomes. Some studies have reported varying effect of adenomyosis on pregnancy outcomes in some patients and dependence on the degree and subtype of uterine lesions. To elucidate the impact of adenomyosis on perinatal outcomes. METHODS This large-scale cohort study used the perinatal registry database of the Japan Society of Obstetrics and Gynecology. A dataset of 203,745 mothers who gave birth between January 2020 and December 2020 in Japan was included in the study. The participants were divided into two groups based on the presence or absence of adenomyosis. Information regarding the use of fertility treatment, delivery, obstetric complications, maternal treatments, infant, fetal appendages, obstetric history, underlying diseases, infectious diseases, use of drugs, and maternal and infant death were compared between the groups. RESULTS In total, 1,204 participants had a history of adenomyosis and 151,105 did not. The adenomyosis group had higher rates of uterine rupture (0.2% vs. 0.01%, P = 0.02) and placenta accreta (2.0% vs. 0.5%, P < 0.001) than the non-adenomyosis group. A history of adenomyosis (odds ratio: 2.26; 95% confidence interval: 1.43-3.27; P < 0.001), uterine rupture (odds ratio: 3.45; 95% confidence interval: 0.89-19.65; P = 0.02), placental abruption (odds ratio: 2.11; 95% confidence interval: 1.27-3.31; P < 0.01), and fetal growth restriction (odds ratio: 2.66; 95% confidence interval: 2.00-3.48; P < 0.01) were independent risk factors for placenta accreta. CONCLUSION Adenomyosis in pregnancies is associated with an increased risk of placenta accreta, uterine rupture, placental abruption, and fetal growth restriction. TRIAL REGISTRATION Institutional Review Board of Tottori University Hospital (IRB no. 21A244).
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Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Tottori prefecture, Tottori, 683-8504, Japan.
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Tottori prefecture, Tottori, 683-8504, Japan
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18
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Olamijulo JA, Okunade KS, Awofeso O, Nwogu CM. Rupture of the Gravid Uterus: A Two-Decade Experience at a University Teaching Hospital in South-West, Nigeria. West Afr J Med 2023; 40:730-735. [PMID: 37515818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
BACKGROUND Uterine rupture is an obstetric emergency associated with significant maternal and perinatal mortality and morbidity, especially in resource-constraint countries such as Nigeria. OBJECTIVE To determine the incidence and feto-maternal outcome of uterine rupture in a Nigerian teaching hospital. METHODS This was a retrospective review of all cases of uterine rupture managed over 21 years. The case notes of all affected women were retrieved, and information on sociodemographic and obstetric characteristics, clinical presentation, intraoperative findings, and fetal and maternal outcomes were extracted. Data were analyzed using SPSS version 23.0 and descriptive statistics were computed. Factors associated with maternal deaths secondary to rupture of the gravid uterus were determined using binary logistic regression analyses. Statistical significance was reported at P<0.05. RESULTS There were 31,616 deliveries during the review period, out of which were 182 cases of uterine rupture giving an incidence of 5.76 per 1,000 deliveries. Most of the cases of uterine rupture (65.2%) were treated by uterine repair. Maternal and fetal deaths were recorded in 8.1% and 82.7% of cases respectively. Women aged at least 35 years (P=0.035), women who had laboured at home or traditional birth attendant's (TBA) place (P=0.002), women who had multiple sites rupture (P=0.049) and those who developed hypovolemic shock (P=0.002) were more likely to die from uterine rupture. CONCLUSION Ruptured uterus remains a significant cause of maternal and perinatal morbidity and mortality in Nigeria. Strategies for prevention include effective health education of the masses, the conduct of labour in a well-equipped health facility, and prompt referral of at-risk women.
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Affiliation(s)
- J A Olamijulo
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos/ Lagos University Teaching Hospital LUTH, Idi-Araba, Lagos, Nigeria
| | - K S Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos/ Lagos University Teaching Hospital LUTH, Idi-Araba, Lagos, Nigeria
| | - O Awofeso
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - C M Nwogu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
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Shen J, Teng X, Chen J, Jin L, Wang L. Intestinal obstruction in pregnancy-a rare presentation of uterine perforation. BMC Pregnancy Childbirth 2023; 23:507. [PMID: 37434108 DOI: 10.1186/s12884-023-05827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/01/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Intestinal obstruction is an uncommon non-obstetric condition during pregnancy which may cause maternal and fetal mortality. Clinicians are confronted with challenges in diagnosis and treatment of intestinal obstruction due to the overlapping symptoms, concerns over radiological evaluation, and surgical risks. CASE PRESENTATION We reported a 39-year old, gravida 7, para 2, woman who suffered from acute intestinal obstruction at 34 weeks of gestation. Ultrasonography and abdominal computed tomography were applied for intestinal obstruction diagnose. Conservative treatment was initially attempted. But following ultrasound found the absence of fluid in the amniotic sac and the patient showed no improvement in clinical symptoms. An emergency caesarean section was then performed. Intra-operative assessment showed dense adhesion between the left wall of uterus and omentum, descending colon, and sigmoid colon. After adhesion dialysis, uterine rupture with complete opening of the uterine wall at the site of left uterine cornua was found without active bleeding. The uterine rupture was then repaired. CONCLUSIONS Although uncommon during pregnancy, clinical suspicion of bowel obstruction is necessary especially in women with a history of abdominal surgery. Surgical intervention is indicated when conservative therapy fails and when there are signs of abnormal fetal conditions and worsened symptoms.
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Affiliation(s)
- Jiayu Shen
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Xinyuan Teng
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Jing Chen
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Ligui Jin
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Liquan Wang
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China.
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20
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Mansoux L, Lejeune-Saada V, Dupuis N, Guerby P. [ Uterine rupture during medical termination of pregnancy or intrauterine death: A risk management study]. Gynecol Obstet Fertil Senol 2023; 51:331-336. [PMID: 36931596 DOI: 10.1016/j.gofs.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To describe and analyze a series of uterine ruptures (UR) that occurred in the context of medical termination of pregnancy (MTP) or intrauterine death (IUD) from a risk management perspective. METHODS French retrospective descriptive observational study of all cases of UR occurring during induction for IUD or MTP, reported between 2011 and 2021 by Gynerisq. Cases were recorded on a basis of voluntary reports using targeted questionnaires. RESULTS Between November 27, 2011, and August 22, 2021, 12 cases of UR occurring during an induction for IUD or MTP were recorded. 50 % of the patients had never given birth by cesarean section. The term of delivery varied from 17+3 days to 41+2 days. The clinical signs found were pain (n=6), ascending fetal presentation (n=5) and bleeding (n=4). All patients were managed by laparotomy, 5 were transfused. One vascular ligation and one hysterectomy were required. CONCLUSION Knowledge of surgical history is involved in the prevention of UR. The signs of detection are pain, ascending presentation and bleeding. The speed of management and good teamwork allow a reduction of maternal complications. The findings of the morbidity and mortality reviews show that prevention and mitigation barriers can be established.
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Affiliation(s)
- Lucile Mansoux
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France.
| | | | - Ninon Dupuis
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France
| | - Paul Guerby
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France
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21
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Bartels HC, Brennan DJ, Timor-Tritsch IE, Agten AK. Global variation and outcomes of expectant management of CSP. Best Pract Res Clin Obstet Gynaecol 2023; 89:102353. [PMID: 37329645 DOI: 10.1016/j.bpobgyn.2023.102353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 06/19/2023]
Abstract
The incidence of Cesarean scar pregnancies (CSPs) is rising globally. Ultrasound criteria for the diagnosis of CSPs have been described by the International Society of Ultrasound in obstetrics and gynecology and appear to be well used in various centers around the world. There is no guidance on best practices for expectant management of CSP, and there is considerable variation in how this is offered globally. Many studies have reported significant maternal morbidity in cases of CSP with fetal cardiac activity managed expectantly, largely relating to hemorrhage and cesarean hysterectomy from placenta accreta spectrum. However, high live birth rates are also reported. Literature describing the diagnosis and expectant management of CSP in low-resource settings is lacking. Expectant management in selected cases where no fetal cardiac activity is present is a reasonable option and can be associated with good maternal outcomes. Standardization in reporting different types of CSPs and correlating these with pregnancy outcomes will be an important next step in developing guidance for expectant management of this high-risk pregnancy with a high burden of complications.
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Affiliation(s)
- Helena C Bartels
- Dept of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
| | - Donal J Brennan
- University College Dublin Gynaecological Oncology Group (UCD-GOG), Mater Misericordiae University Hospital and St Vincent's University Hospital, Dublin, Ireland.
| | | | - Andrea Kaelin Agten
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, L8 7SS, United Kingdom.
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22
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Cohen N, Arush L, Younes G, Lavie O, Goldberg Y. Cesarean scar niche, fertility and uterine rupture during labor - A retrospective study. Eur J Obstet Gynecol Reprod Biol 2023; 286:107-111. [PMID: 37235927 DOI: 10.1016/j.ejogrb.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To determine how does a uterine niche diagnosed prior to conception, affects future fertility and obstetrical outcomes, in a group of patients with secondary infertility undergoing fertility treatments. STUDY DESIGN A retrospective case-control study was performed, recruiting patients after cesarean delivery, before fertility treatment. Using stored ultrasound photos and video loops, we determined niche's sonographic parameters during the preconception period and retrieved the fertility and obstetrical outcomes thereafter. RESULTS 104 patients met the inclusion criteria, and 86 were available for analysis. 56 (65%) had uterine niches larger than 2 mm in depth, and 30 (34%) had a uterine scar of 2 mm or less. Demographic characteristics were not different between groups. No statistically significant differences were observed regarding rates of implantation and clinical pregnancy between the groups. There were four cases of cesarean scar rupture during failed trial of labor (TOLAC), all of which were in the group with larger than 2 mm niche (33% of all TOLAC cases in the respected group). CONCLUSIONS While it appears that pre-conception presence of uterine niches larger than 2 mm in depth does not adversely affect future fertility, these niches might serve as a risk factor for future uterine rupture during TOLAC.
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Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel; The Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Lior Arush
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Grace Younes
- Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel; The Rappaport Faculty of Medicine, Technion, Haifa, Israel; Division of Reproduction Center, Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel; The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yael Goldberg
- Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel; The Rappaport Faculty of Medicine, Technion, Haifa, Israel; Unit of Gynecological and Obstetrical Ultrasound, Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel
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23
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Algeri P, Spazzini DM, Seca M, Garbo S, Villa A. A uterine malformation diagnosed in the shock room: a case report which helps to identify how to avoid a potentially preventable life-threatening event. J Ultrasound 2023; 26:151-154. [PMID: 36030354 PMCID: PMC10063735 DOI: 10.1007/s40477-022-00706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
An Indian wonen at her second pregnancy, with a previous preterm labour at 34.5 weeks, presented to the emergency room at 15.6 weeks, shocked due to massive hemoperitoneum. During the urgent surgery, a Mullerian malformation was detected, and a uterine rupture was diagnosed as the cause of the hemoperitoneum. Ultrasound and pelvic magnetic resonance results confirmed the malformation, determining that a unicornuate uterus with a rudimental horn within the pregnancy had taken place. We decided to report our case to underline that Mullerian malformation must be taken into consideration and evaluated at each routinary gynaecological visit or, at least, at the first pregnancy appointment, especially in the cases of women with previous adverse obstetric outcomes. The 2D abdominal ultrasound associated with trans-vaginal evaluation is an adequate procedure to test for suspected uterine malformations (if the operator keeps it in mind and is trained to check this kind of alteration), which is fundamental to reducing the risk of life-threatening events.
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Affiliation(s)
- Paola Algeri
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy.
| | - Donata Maria Spazzini
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Marta Seca
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza e Brianza, Italy
| | - Stefano Garbo
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Antonella Villa
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
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Chen P, Liu X, Fang C, Zhao W. Angular pregnancy after in-vitro fertilization with timely termination to avoid uterine rupture: A case report. Asian J Surg 2022:S1015-9584(22)01769-9. [PMID: 36575099 DOI: 10.1016/j.asjsur.2022.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/16/2022] [Indexed: 12/26/2022] Open
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Zepf J, Vonzun L, Krähenmann F, Strübing N, Moehrlen U, Meuli M, Mazzone L, Moehrlen T, Ochsenbein-Kölble N. Subsequent Pregnancy Outcomes after Open in utero Spina Bifida Repair. Fetal Diagn Ther 2022; 49:442-450. [PMID: 36455544 DOI: 10.1159/000527813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/26/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Fetal spina bifida (SB) repair is a distinct therapeutic option in selected cases. Since this procedure may not only be associated with short-term obstetrical complications, the aim of this study was to assess the outcomes of subsequent pregnancies after open fetal SB repair. METHODS 138 patients having had open fetal SB repair at our center received a questionnaire regarding the occurrence, course, and outcome of subsequent pregnancies. Additionally, medical records were reviewed. All subsequent pregnancies with complete outcome data that progressed beyond 20 gestational weeks (GW) were included for further analysis. RESULTS 70% of all women answered the questionnaire. Out of this cohort, 35 subsequent pregnancies were reported in 29% of women. The rate of early pregnancy loss including elective terminations was 14%. All 29 pregnancies processing >20 GW ended in live births without preterm births <34th GW. Mean gestational age at delivery was 37.3 ± 1.4 GW. Uterine rupture occurred in two cases (7%) and uterine thinning/dehiscence was present in six cases (21%). No maternal transfusions were required. CONCLUSION When counseling women undergoing open fetal SB repair, one should consider possible risks for subsequent pregnancies, especially the one of uterine dehiscence and rupture that is similar compared to numbers reported after classical cesarean deliveries.
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Affiliation(s)
- Julia Zepf
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Ladina Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Franziska Krähenmann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Nele Strübing
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Ueli Moehrlen
- University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Meuli
- University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Luca Mazzone
- The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Theres Moehrlen
- The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
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Anand A, Gupta A, Yadav P, Rijal P. Suspected illegal abortion and unsafe abortion leading to uterine rupture and incomplete abortion: A case report. Ann Med Surg (Lond) 2022; 84:104933. [PMID: 36582916 PMCID: PMC9793220 DOI: 10.1016/j.amsu.2022.104933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Unsafe abortions are more prevalent in developing countries and countries with restrictive abortion laws, and can lead to significant maternal mortality. Usually, the presentation includes abdominal pain, fever and vaginal bleeding. Case presentation We reported the case of a female in her twenties in her second trimester of pregnancy following unsafe abortion. The patient had abdominal pain, and laboratory investigations revealed anemia and leucocytosis. The patient opted for abortion as the foetus was identified as female by a service provider. Due to unsafe and illegal abortion, the patient developed complications of incomplete abortion and uterine rupture. She was successfully managed by emergency laparotomy followed by repair of uterine rupture and symptomatic management. Clinical discussion Unsafe abortion can lead to complications such as incomplete abortion and uterine rupture. Complications due to abortion are more frequent if not performed by experienced surgeons. In our case, the manual vacuum and aspiration technique was used during the second trimester of pregnancy, which led to uterine perforation. Conclusion Our case highlighted the importance of safe abortion practices and the approach to clinical management of complications of unsafe abortion. Also, global health problems such as unsafe abortion, illegal abortion, sex-selective abortion, and violation of ethical conduct need to be addressed to curb unsafe abortion.
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Affiliation(s)
- Ayush Anand
- BP Koirala Institute of Health Sciences, Dharan, Nepal
- Corresponding author.
| | - Ashwini Gupta
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Punita Yadav
- Department of Obstetrics and Gynaecology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Pappu Rijal
- Department of Obstetrics and Gynaecology, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Locher S, Jellouli MA, Mathis J, Ha DE. Spontaneous rupture of an unscarred uterus in a woman at 37 weeks of pregnancy with abdominal pain: a case report. AJOG Glob Rep 2022; 2:100082. [PMID: 36591603 PMCID: PMC9794560 DOI: 10.1016/j.xagr.2022.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A 34-year-old gravida 2, para 1 woman at 37+4 weeks of pregnancy presented with abdominal pain. She had no medical history. Complete examination was unremarkable. After hours of monitoring, the patient abruptly deteriorated. An emergency cesarean delivery revealed a ruptured uterus with significant issues. Cautious monitoring is essential for such patients with atypical pain.
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Eboh S, Burghul S, Galloway M, Sanchez A, Ventolini G. Preterm Complete Uterine Rupture With En Caul Expulsion. Clin Med Insights Case Rep 2022; 15:11795476221112376. [PMID: 35845355 PMCID: PMC9280791 DOI: 10.1177/11795476221112376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/17/2022] [Indexed: 12/01/2022] Open
Abstract
Spontaneous uterine rupture is a catastrophic obstetric complication for both the mother and fetus. We highlight a case of a 32-year-old G2P1A0L1 Hispanic female at 36 weeks gestation who presented to the labor and delivery unit with minimal prenatal care, complaining of abdominal pains and vaginal bleeding. An abdominopelvic ultrasound confirmed an empty uterus and fetal demise in the abdominal cavity, leading to an exploratory laparotomy to evacuate the fetus. At surgery, a preterm sized fetus “en caul” with intact amnions was floating in the abdominal cavity and a hemostatic, complete rupture of the anterior uterine wall was discovered. Uterus was repaired and the patient recovered postoperatively without complications. Despite the best evidence suggesting that a history of low-transverse Cesarean section poses a low risk for spontaneous uterine rupture, this complication should always be considered and patients should be counseled regardless of the low risk should they desire a cesarean section.
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Affiliation(s)
- Stanley Eboh
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Suna Burghul
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Michael Galloway
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Asley Sanchez
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
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Alalaf SK, Mansour TMM, Sileem SA, Shabila NP. Intrapartum ultrasound measurement of the lower uterine segment thickness in parturients with previous scar in labor: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:409. [PMID: 35568830 PMCID: PMC9107280 DOI: 10.1186/s12884-022-04747-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is a lack of reliable methods to estimate the risk of uterine rupture or dehiscence during a trial of labor in women with previous cesarean sections. This study aimed to assess the lower uterine segment and myometrial thickness by ultrasonography in women with previous cesarean sections during labor and assess their association with the uterine defect. Methods A cross-sectional study was conducted on 161 women in the active phase of labor having one previous cesarean section. The study was conducted et al.-Azhar University Hospital, Assiut City, Egypt, from March 2018 to March 2019. Ultrasound measurements of lower uterine segment thickness and myometrial thickness were conducted by vaginal and abdominal ultrasound by two observers. The correlation of both thicknesses with the uterine defect was analyzed. Results Uterine defects were reported in 42 women (25.9%), uterine rupture in four women (2.5%), and dehiscence in 38 women (23.5%). The uterine defects were not associated with maternal factors (maternal age, gestational age at labor, body mass index, birth weight, interpregnancy, and inter-delivery interval). Receiver operating curve analysis demonstrated that lower uterine segment thickness was linked with uterine defect, with an area under the curve of 60% (95% CI, 51–70%, P = 0.044). Myometrial thickness was also linked to the uterine defect, with an area under the curve of 61% (95% CI, 52–71%, P = 0.025). Full lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm were the cutoff value with the best combination of sensitivity and specificity for the uterine defect. Lower uterine segment thickness (OR = 0.49, 95%CI 0.24–0.96) and myometrial thickness (OR = 0.44, 95%CI 0.20–0.94) were significantly associated with the uterine defect. Lower uterine segment thickness (OR = 0.41, 95%CI 0.22–0.76) and myometrial thickness (OR = 0.33, 95%CI 0.16–0.66) were also significantly associated with cesarean section delivery. Conclusion A lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm during the first stage of labor are associated with a high risk of uterine defects during a labor trial. These measurements during labor can have a practical application in deciding the mode of delivery in women with previous cesarean sections and might reduce uterine rupture.
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Affiliation(s)
- Shahla K Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Kurdistan Region, Erbil city, Iraq
| | | | - Sileem Ahmad Sileem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Nazar P Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Kurdistan Region, Erbil City, Iraq.
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Vivanti AJ, Nhung NTH, Ha CTT, Cong NH, Bac DV, de Thorey AG, Benachi A, Deffieux X, Le DTH. Successful conservative management of a spontaneous hemorrhagic uterine rupture at 18 weeks of gestation. J Gynecol Obstet Hum Reprod 2022; 51:102396. [PMID: 35489714 DOI: 10.1016/j.jogoh.2022.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/19/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Prelabor uterine rupture is a very rare complication of pregnancy that in most cases occurs when there is a history of uterine surgery. Maternal and neonatal morbidity is significant. Most often, the pregnancy must be terminated to rescue both the mother and the newborn, if possible. We report the case of a patient who had a pre-labor uterine rupture at 18 weeks of gestation (WG) complicated by massive hemoperitoneum. Emergency surgery with conservative management allowed the pregnancy to continue until 32+3 WG. In very rare situations of uterine rupture at a very early term, conservative management appears to be an acceptable solution to allow the pregnancy to continue until a sufficient gestational age to limit complications related to prematurity.
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Affiliation(s)
- Alexandre J Vivanti
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France.
| | | | - Cao Thi Thuy Ha
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Nguyen Huu Cong
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Duong Viet Bac
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Axelle Gillet de Thorey
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Xavier Deffieux
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Dinh Thi Hien Le
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
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Boujida S, M'Hamdi O, Flissate F, Baidada A, Kharbach A. Placenta percreta as a cause of uterine rupture in the second trimester: Case report. Int J Surg Case Rep 2022; 94:107069. [PMID: 35462146 PMCID: PMC9046604 DOI: 10.1016/j.ijscr.2022.107069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Placenta accreta spectrum is a very life-threatening obstetrical condition whose rate increased significantly the past years due to the increase of caesarean deliveries. In some rare cases, it can cause uterine rupture which needs to be diagnosed and managed quickly to avoid catastrophic outcomes. Case report We present a case of a 33-year-old patient who was admitted to the emergency room for signs of shock at 29 weeks of a poorly supervised pregnancy, secondary to a spontaneous uterine rupture on a previously scarred uterus by a caesarean delivery two years prior to the events. She presented with massive haemoperitoneum with no vaginal bleeding. Foetus was in bradycardia. Quick total hysterectomy allowed favorable maternal and foetal outcome. Discussion Placenta accreta spectrum (PAS) occurs when the placenta becomes abnormally adherent to the myometrium and serosa rather than the uterine decidua. Its most important complication is hemorrhage after delivery of the placenta. In rare cases it can lead to spontaneous uterine rupture at any trimester, as it was the case of our patient. Antepartum diagnosis by ultrasound examination is recommended to avoid complications and improve management. It should be carefully done in high-risk patients of PAS. PAS is associated with high maternal and foetal morbidity and mortality. Definitive diagnosis is obtained after pathology examination of the specimen. Conclusion Uterine rupture should be considered a differential diagnosis for abdominal pain in any trimester, in case of shock even in the absence of vaginal bleeding, especially when associated to abnormal placentation. Quick diagnosis, management and intervention improves survival rate and decreases maternal and foetal morbidity. Placenta percreta is a rare but must be known cause of midgestational spontaneous uterine rupture Antepartum diagnosis helps prevent hemorrhage complications Early identifiation of clinical signs, and utilization of ultrasound helps establish a diagnosis and increase survival rate Quick management and surgery improve maternal and foetal outcome
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Affiliation(s)
- Sarah Boujida
- Department of Gynecology and Obstetrics, Maternity of Souissi, Faculty of Medicine, Mohamed V Souissi University, Rabat, Morocco.
| | - Oumaima M'Hamdi
- Department of Gynecology and Obstetrics, Maternity of Souissi, Faculty of Medicine, Mohamed V Souissi University, Rabat, Morocco
| | - Farah Flissate
- Department of Gynecology and Obstetrics, Maternity of Souissi, Faculty of Medicine, Mohamed V Souissi University, Rabat, Morocco
| | - Aziz Baidada
- Department of Gynecology and Obstetrics, Maternity of Souissi, Faculty of Medicine, Mohamed V Souissi University, Rabat, Morocco
| | - Aicha Kharbach
- Department of Gynecology and Obstetrics, Maternity of Souissi, Faculty of Medicine, Mohamed V Souissi University, Rabat, Morocco
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Jha N, Madhuri MS, Jha AK, Kubera NS. Subsequent Pregnancy Outcome in Women with Prior Complete Uterine Rupture: A Single Tertiary Care Centre Experience. Reprod Sci 2022; 29:1506-1512. [PMID: 35246823 DOI: 10.1007/s43032-022-00906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022]
Abstract
Limited data is available to assess the burden of maternal morbidity, mortality, and perinatal outcome after subsequent pregnancy in women with prior uterine rupture. Therefore, this retrospective descriptive study was conducted to determine subsequent pregnancy outcomes in a larger series of women with prior complete uterine rupture. All pregnant women who had complete uterine rupture were managed according to the standard Institute protocol. The women who conceived following a uterine repair from July 2011 to June 2020 were recruited into the study. Outcome measures included severe maternal morbidities and perinatal outcomes. Fifty-three women with prior complete uterine rupture were conceived subsequently. Two women had an abortion in the first and second trimester, respectively. None of the women developed recurrence of uterine rupture. However, three women developed uterine dehiscence in a total of 16 women who went into spontaneous labour before elective cesarean delivery at 32, 36, and 37 weeks, respectively. None of the women had placenta previa, placenta accreta, bowel injury, bladder injury and none required a hysterectomy. However, 16.7% of women needed a blood transfusion. None of the women required mechanical ventilation, inotropic support, and intensive care unit stay. Seventeen babies required neonatal intensive care admission, and prematurity (90%) was the most common reason, followed by low APGAR scores. In conclusion, subsequent pregnancy outcomes in women with prior uterine rupture appear acceptable in institutionalized care. Timing of cesarean delivery may have to be weighed against the risk of prematurity-associated neonatal morbidity and mortality.
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Affiliation(s)
- Nivedita Jha
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
| | - M S Madhuri
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - N S Kubera
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Sugai S, Tsuneki I, Yanase T, Kurabayashi T. Computed tomography in postpartum hemorrhage due to incomplete rupture of an unscarred uterus. Arch Gynecol Obstet 2022; 305:851-853. [PMID: 35179627 PMCID: PMC8967755 DOI: 10.1007/s00404-022-06454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynaecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata, 950-1197, Japan.
| | - Ikunosuke Tsuneki
- Department of Obstetrics and Gynaecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Toru Yanase
- Department of Obstetrics and Gynaecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Takumi Kurabayashi
- Department of Obstetrics and Gynaecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata, 950-1197, Japan
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Tao J, Mu Y, Chen P, Xie Y, Liang J, Zhu J. Pregnancy complications and risk of uterine rupture among women with singleton pregnancies in China. BMC Pregnancy Childbirth 2022; 22:131. [PMID: 35172764 PMCID: PMC8851699 DOI: 10.1186/s12884-022-04465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to investigate whether pregnancy complications are associated with an increased risk of uterine rupture (UR) and how that risk changes with gestational age. METHODS We obtained all data from China's National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2018. Poisson regression analysis was used to assess the risk of UR with pregnancy complications (preeclampsia, gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta) among 9,454,239 pregnant women. Furthermore, we analysed the risks of UR with pregnancy complications in different gestational age groups. RESULTS The risk of UR was increased 2.0-fold (1.2-fold to 2.7-fold) in women with pregnancy complications (except for preeclampsia). These associations also persisted in women without a previous caesarean delivery. Moreover, an increased risk of UR before term birth was observed among women with gestational diabetes mellitus, placental abruption and placenta percreta. The risk of UR was slightly higher in women with gestational diabetes mellitus who had a large for gestational age (LGA) foetus, especially at 32 to 36 weeks gestation. CONCLUSIONS The risk of UR is associated with gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta, but varies in different gestational ages.
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Affiliation(s)
- Jing Tao
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peiran Chen
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanxia Xie
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
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Wan S, Yang M, Pei J, Zhao X, Zhou C, Wu Y, Sun Q, Wu G, Hua X. Pregnancy outcomes and associated factors for uterine rupture: an 8 years population-based retrospective study. BMC Pregnancy Childbirth 2022; 22:91. [PMID: 35105342 PMCID: PMC8805328 DOI: 10.1186/s12884-022-04415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications. Methods This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were reviewed retrospectively. Results A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10000 births. Among the 41 cases, 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all cases, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcomes, such as fetal death. 24 (59.0%) of the ruptures occurred in anterior lower uterine segment. Changes in Fetal heart rate monitoring were the most reliable signs for rupture. Conclusions Incidence of uterine rupture in the study area, Shanghai, China was consistent with developed countries. Further improvements in obstetric care and enhanced collaboration with referring health facilities were needed to ensure maternal and perinatal safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04415-6.
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Affiliation(s)
- Sheng Wan
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Mengnan Yang
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Jindan Pei
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Xiaobo Zhao
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Chenchen Zhou
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Yuelin Wu
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Qianqian Sun
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Guizhu Wu
- Department of Gynecology, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
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Yang Y, He F. Placenta percreta complicated with uterine rupture. Arch Gynecol Obstet 2022; 305:291-292. [PMID: 35018516 DOI: 10.1007/s00404-021-06340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Yilin Yang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, Guangdong, China
| | - Fang He
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China.
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, Guangdong, China.
- Guangzhou Medical Centre for Critical Pregnant Women, Guangzhou, 510150, Guangdong, China.
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Fané S, Bocoum A, Traoré SO, Kanté I, Sylla C, Sissoko A, Traoré A, Sima M, Sanogo SA, Kouma A, Sanogo A, Sylla M, Adiawiakoye A, Coulibaly M, Teguété I, Traoré Y, Mounkoro N. [Risk factors and management of uterine rupture in a 1st reference structure in Mali: case of the Bougouni health district]. Mali Med 2022; 37:15-22. [PMID: 38514953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
The objective was to assess the risk factors for and to suggest therapeutic aspects. MATERIALS AND METHODS We carried out a case-control study at the Bougouni Reference health center in 2019. RESULTS From January to December 31, 2019; out of 1161 deliveries, 43 uterine rupture were recorded, 3.7% corresponding to one uterine rupture for 27 deliveries. Patients 35 years and older were more affected by uterine rupture (44.2%) with ORaIC95% = 6.3 [1.5 - 26.3]. Obstetric evacuations had an ORaIC95% = 25.6 [7.8-83.7]. All of the patients were housewives (97.7%) versus (82.3%) controls with ORaIC95% = 8.9 (1.1-69). Pauciparous and multiparous had an ORaIC95% = 6.2 [1.8 - 20.3] and 4.1 [1.3 - 12.9], respectively. The uterine scar (20.9%) of cases versus 8.1% of controls had a 95% ORaIC95% = 2.9 [1.1 - 8.7]. Indeed the absence of ANC was a risk factor, ORaIC95% = 3.0 [1.3 - 6.9]. The time to uterine rupture was < 6 hours in 95%. In fact 34 complete uterine rupture (79.1%) and 9 incomplete uterine rupture (20.9) were noted. Only 2.3% of cases gave birth vaginally. Treatment of uterine rupture was based on surgery (100%) supplemented by shock (51.2%) of cases and infection (100%) of cases. CONCLUSION Uterine rupture is common in our countries under medical care. Its effective prevention involves strategies aimed at acting on risk factors.
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Affiliation(s)
- Seydou Fané
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
| | - Amadou Bocoum
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
| | - Soumana Oumar Traoré
- Service de gynécologie obstétrique du centre de santé de référence de la commune V de Bamako, Mali
| | - Ibrahima Kanté
- Département de gynécologie obstétrique du CHU du Point G, Bamako, Mali
| | - Cheickna Sylla
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
| | - Abdoulaye Sissoko
- Département de gynécologie obstétrique de l'Hôpital Mère-enfant le Luxembourg à Bamako, Mali
| | | | - Mamadou Sima
- Département de gynécologie obstétrique du CHU du Point G, Bamako, Mali
| | - Siaka Amara Sanogo
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
| | - Aminata Kouma
- Département de gynécologie obstétrique du CHU de Kati, Koulikoro, Mali
| | - Abdoulaye Sanogo
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
| | - Mala Sylla
- Service de gynécologie obstétrique du centre de santé de référence de Bougouni, Sikasso, Mali
| | - Adane Adiawiakoye
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
| | - M Coulibaly
- Service de gynécologie obstétrique du centre de santé de référence de Bougouni, Sikasso, Mali
| | - Ibrahima Teguété
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
| | - Youssouf Traoré
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
| | - Niani Mounkoro
- Département de gynécologie obstétrique du CHU Gabriel Touré de Bamako, Mali
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Mariye YF, Weldetensay EK, Dribisa W. Unusual Posterior Wall Uterine Rupture with the Use of Misoprostol for Second Trimester Pregnancy Termination. Ethiop J Health Sci 2022; 32:213-216. [PMID: 35250233 PMCID: PMC8864404 DOI: 10.4314/ejhs.v32i1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
Abortion is defined as the termination of pregnancy before the fetus is viable. It is one of the most commonly performed procedures in gynecological departments worldwide. Termination of pregnancy in second trimester is one of the greatest challenges because of multiple modes of termination options with their risks of complication and making it riskier than the first trimester termination. We report this case because of a rare occurrence of posterior wall rupture which would have led to grave complication if not anticipated and detected early.
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Affiliation(s)
| | | | - Weyesa Dribisa
- Department of Obstetrics and Gynecology, School of Medicine, Addis Ababa University
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Agarwal S, D'Souza R, Dy J. Induction of labour in patients with prior caesarean births or uterine surgery. Best Pract Res Clin Obstet Gynaecol 2021; 79:95-106. [PMID: 35012884 DOI: 10.1016/j.bpobgyn.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/02/2022]
Abstract
The current evidence favours trial of labour after one caesarean in the absence of any other contraindications, recognizing that risks with both trial of labour after caesarean (TOLAC) and elective repeat caesarean section (ERCS) birth are relatively uncommon. When the need for induction of labour (IOL) following a previous caesarean arises, shared decision-making should be based on the current available evidence. This approach, however, needs to be tailored, taking into account the individual's history, initial examination and response to the ongoing process of induction to optimize the maternal and foetal outcomes. This paper aims to review the evidence and provide guidance on decision making surrounding labour induction in a pregnancy following a prior caesarean or uterine surgery.
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Affiliation(s)
- Sugandha Agarwal
- Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, K1H8L6, ON, Canada.
| | - Rohan D'Souza
- Department of Obstetrics and Gynecology, McMaster University, 501 Smyth Road, Ottawa, K1H8L6, ON, Canada.
| | - Jessica Dy
- Department of Obstetrics and Gynecology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H8L6, Canada.
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Zhao P, Zhao Y, He J, Bai XX, Chen J. Subsequent placenta accreta after previous mifepristone-induced abortion: A case report. World J Clin Cases 2021; 9:10244-10248. [PMID: 34904095 PMCID: PMC8638051 DOI: 10.12998/wjcc.v9.i33.10244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/22/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mifepristone-induced abortion (MIA) has been used worldwide to terminate pregnancies. However, the association between placenta accrete (PA) and MIA has seldom been reported.
CASE SUMMARY A 26-year-old pregnant woman presented with painless vaginal bleeding at 35 wk of gestation. She had a medical abortion (mifepristone followed by misoprostol) 1 year ago at the sixth week of gestation. Her personal history for previous surgery was negative. Abdominal ultrasonography showed a normal foetus with complete placenta previa. The foetal membrane ruptured with massive vaginal bleeding and severe abdominal pain. An emergency Caesarean section was performed, and the newborn was delivered. The placenta failed to expel and manual extraction was carried out. A large defect was noted in the uterine fundus and repair of the uterine rupture was conducted immediately. The postoperative pathology report showed placenta accreta.
CONCLUSION The evidence suggests a possible etiologic role of MIA in PA, as the incidence of PA after MIA is much higher than general population. Millions of pregnancies are complicated by PA each year, some of which result in fatality. To prevent subsequent placental complications after MIA, hormonal supplementation might be a promising therapeutic options. However, further studies are needed to identify the high-risk factors and to confirm the effectiveness of estrogen supplement therapy.
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Affiliation(s)
- Peng Zhao
- Department of Obstetrics, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
| | - Ying Zhao
- Department of Obstetrics, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
| | - Jing He
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xiao-Xia Bai
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Jian Chen
- Department of Ultrasonography, the Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
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Caruso G, Paladini V, D'ambrosio V, Giancotti A, Piccioni MG, Palaia I, Di Donato V, Perniola G, Brunelli R, Pecorini F, Muzii L, Scudo M. Combined vesico uterine rupture during second-trimester medical abortion for fetal abnormality after prior cesarean delivery: A case report. Case Rep Womens Health 2021; 32:e00364. [PMID: 34765461 PMCID: PMC8570940 DOI: 10.1016/j.crwh.2021.e00364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The use of mifepristone and misoprostol for the induction of a second-trimester abortion is common and effective. However, its safety in women with previous cesarean delivery is still controversial, given the potentially higher risk of uterine rupture. Case presentation We present the case of a 30-year-old woman (G2P1) who experienced vesicouterine rupture with escape of the dead fetus into the bladder during second-trimester induced abortion after prior cesarean delivery. She was successfully managed with conservative surgery. Conclusion This case highlights the challenges of early diagnosis of vesicouterine rupture during second-trimester medical abortion. We argue that a close monitoring of patients with prior cesarean section is mandatory, particularly if uterine contractions suddenly stop or the fetal head fails to descend. A prompt conservative surgical approach allows preservation of fertility. The use of mifepristone/misoprostol for the induction of abortion is common and effective. For women who have previously had a cesarean delivery, there is a higher risk of uterine rupture. Diagnosis of vesicouterine rupture is challenging and close monitoring is mandatory.
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Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Vanessa Paladini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Valentina D'ambrosio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Maria Grazia Piccioni
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Pecorini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Maria Scudo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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Aichouni N, Belharti A, Saadi H, Mimouni A, Nasri S, Skiker I. Spontaneous uterine rupture of an unscarred uterus revealed by a subocclusive syndrome: A case report and review of the literature. Radiol Case Rep 2021; 16:3787-3789. [PMID: 34646409 PMCID: PMC8501686 DOI: 10.1016/j.radcr.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Spontaneous uterine rupture of an unscarred uterus is a complication that has dramatic results for both mother and fetus. The clinical presentation commonly comprises abdominal pain and metrorrhagia however we report a case of spontaneous uterine rupture revealed by a subocclusive syndrome. We report a case of a young woman who came to the ER with 3 days of progressive abdominal pain and subocclusive syndrome. The current pregnancy was estimated at 32 weeks of amenorrhea and the patient was hemodynamically stable. An obstetric ultrasound was performed showing a progressive monofoetal pregnancy and moderate peritoneal effusion. In view of the presence of effusion on ultrasound and the subocclusive syndrome, an abdominal and pelvic CT scan with contrast was carried out, showing a fundal uterine rupture defect with contrast media extravasation and intraperitoneal hemoperitoneum. The patient was immediately transferred to the operating room for a caesarean section. Although CT scans use radiation, their contribution was essential to avoid maternal death.
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Affiliation(s)
- Narjisse Aichouni
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Aahd Belharti
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Hanane Saadi
- Department of Obstetrics and Gynecology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Ahmed Mimouni
- Department of Obstetrics and Gynecology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
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Guerby P, Bujold E, Chaillet N. Impact of third-trimester measurement of low uterine segment thickness and estimated fetal weight on perinatal morbidity in women with prior cesarean. J Obstet Gynaecol Can 2021:S1701-2163(21)00760-X. [PMID: 34656771 DOI: 10.1016/j.jogc.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to estimate the impact of third-trimester ultrasound with measurement of the lower uterine segment thickness (LUST) and estimation of fetal weight (EFW) on maternal and perinatal morbidity among women with a prior cesarean delivery. METHODS We performed a secondary analysis of the QUARISMA trial, including women who delivered at term after 1 prior cesarean delivery in tertiary care centres. Major and minor maternal and perinatal morbidities were compared between centres that had introduced LUST and EFW measurements into routine practice and those that had not, using generalized estimating equations and adjusted odds ratios (aOR). In a secondary analysis, we compared women who underwent a trial of labour with and without LUST and EFW measurements. RESULTS We observed a significant reduction in major perinatal morbidity (aOR 0.52; 95% CI 0.28-0.96, P = 0.04), minor perinatal morbidity (aOR 0.49; 95% CI 0.25-0.96, P = 0.04), and minor maternal morbidity (aOR 0.56; 95% CI 0.34- 0.94, P = 0.03) but no significant difference in major maternal morbidity (aOR 0.40; 95% CI 0.04-3.69, P = 0.42) in the 2 centres that had introduced third-trimester ultrasound with EFW and LUST measurements (1458 women), compared with the 4 centres (1247 women) that had not. Among women who underwent a trial of labour, we observed a reduction in major perinatal morbidity (aOR 0.25; 95% CI 0.11-0.54, P < 0.001) and a lower rate of uterine rupture (0% vs. 0.3%, P = 0.045) with LUST and EFW measurements. CONCLUSION Third-trimester ultrasound with EFW and LUST measurement is associated with a significant reduction in major perinatal morbidity in women with a prior caesarean delivery.
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Aboughalia H, Basavalingu D, Revzin MV, Sienas LE, Katz DS, Moshiri M. Imaging evaluation of uterine perforation and rupture. Abdom Radiol (NY) 2021; 46:4946-66. [PMID: 34129055 DOI: 10.1007/s00261-021-03171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
Uterine perforation and rupture, denoting iatrogenic and non-iatrogenic uterine wall injury, respectively, are associated with substantial morbidity,and at times mortality. Diverse conditions can result in injury to both the gravid and the non-gravid uterus, and imaging plays a central role in diagnosis of such suspected cases. Ultrasound (US) is the initial imaging modality of choice, depicting the secondary signs associated with uterine wall injury and occasionally revealing the site of perforation. Computed tomography can be selectively used to complement US findings, to provide a more comprehensive picture, and to investigate complications beyond the reach of US, such as bowel injury. In certain scenarios, magnetic resonance imaging can be an important problem-solving tool as well. Finally, catheter angiography is a valuable tool with both diagnostic and therapeutic capability, with potential for fertility preservation. In this manuscript, we will highlight the clinical and imaging approach to uterine perforation and rupture, while emphasizing the value of various imaging modalities in this context. In addition, we will review the multi-modality imaging features of uterine perforation and rupture and will address the role of the radiologist as a crucial member of the management team. Finally, a summary diagrammatic depiction of imaging approach to patients presenting with uterine perforation or rupture is provided.
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El Miski F, Benjelloun AT, Bouab M, Lamrissi A, Fichtali K, Bouhya S. Spontaneous uterine rupture during the first trimester of a partial molar pregnancy in a scar uterus: A rare case report. Int J Surg Case Rep 2021; 85:106229. [PMID: 34325299 PMCID: PMC8329478 DOI: 10.1016/j.ijscr.2021.106229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Spontaneous uterine rupture in the first trimester is a redoubtable obstetric emergency that carries a high risk for both mother and fetus. Cases presentation We present the case of a spontaneous uterine rupture in a patient with a scarred uterus at 9 weeks' gestation treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca; whose histological examination of the removed material found a partial mole. Clinical discussion Spontaneous uterine rupture in the first trimester is rare and usually occurs in a scarred or malformed uterus. Clinicians should consider this diagnosis in the presence of an acute abdominal pain in early pregnancy with or without first trimester metrorrhagia. Conclusion Since the rate of uterine surgeries is increasing, it is necessary to highlight the risk of uterine rupture occurring early in order to improve their management. Molar pregnancy is a factor of fragility of the uterine wall and uterine rupture must be suspected in any molar pregnancy associated with a hemoperitoneum. Spontaneous uterine rupture in the first trimester is rare. Diagnosis suspected in the presence of any acute abdominal pain in early pregnancy. Uterine scarring is the main factor promoting early uterine rupture
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Affiliation(s)
- F El Miski
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - A Touimi Benjelloun
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - M Bouab
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - A Lamrissi
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - K Fichtali
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - S Bouhya
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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Hou JH, Lee TH, Wang SY, Lai HC, Mao SP. Spontaneous uterine rupture at a non-cesarean section scar site caused by placenta percreta in the early second trimester of gestation: A case report. Taiwan J Obstet Gynecol 2021; 60:784-786. [PMID: 34247827 DOI: 10.1016/j.tjog.2021.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Risk factors for placenta percreta are placenta previa and prior cesarean delivery. Placenta percreta-induced ruptures at non-cesarean sites are very rare, particularly in the early second trimester. CASE REPORT A 30-year-old woman with a prior cesarean delivery was brought to our emergency department at 17 weeks' gestation for sudden-onset consciousness loss and generalized convulsions. Hypovolemic shock was identified. Computed tomography scans suggested uterine rupture and massive ascites, r/o hemoperitoneum. Emergency exploratory laparotomy revealed a ruptured hole over the left uterine fundus with protruding placental tissue; placenta percreta was impressed. An intact intrauterine sac was dissected and removed. The placenta was removed and hysterorrhaphy was completed. CONCLUSION Placenta percreta is dangerous and is rarely seen in the early second trimester. Uterine rupture should always be kept in mind in pregnant woman with acute abdomen associated with hypovolemic shock, even in those of early pregnancy without scarred uterus. Routine sonographic examination of placentation, even in early second trimester, should be emphasized.
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Affiliation(s)
- Jung-Hsiu Hou
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tung-Heng Lee
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Sheng-Yuan Wang
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hung-Chung Lai
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Peng Mao
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
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Donati S, Fano V, Maraschini A. Uterine rupture: Results from a prospective population-based study in Italy. Eur J Obstet Gynecol Reprod Biol 2021; 264:70-75. [PMID: 34274701 DOI: 10.1016/j.ejogrb.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the incidence of uterine rupture (UR), and evaluate risk factors, management, and associated maternal and perinatal outcomes. STUDY DESIGN This multicentre prospective population-based study involved six regions in Italy accounting for 49% of national births. The study population comprised all women aged 11-59 years delivering at ≥22 gestational weeks with a diagnosis of UR from September 2014 to August 2016. Maternal and pregnancy characteristics and information on potential risk factors were collected. Unadjusted relative risks (RR) and 95% confidence intervals (CI) were computed with respect to the background population. RESULTS In total, 74 cases of UR occurred among the study population (rate 0.16/1000 pregnancies; mean age 34 years; 14 perinatal deaths, one maternal death). A significantly higher risk of UR was observed for maternal age ≥ 35 years (RR = 1.58, 95% CI 1.00-2.51), multiparity (RR = 5.71, 95% CI 3.14-10.04), previous caesarean section (RR = 20.5, 95% CI 11.11-37.74) and uterine scarring (RR = 6.44, 95% CI 2.94-14.12). A significant association was observed between UR and caesarean section as the mode of delivery (RR = 27.9, 95% CI 10.2-76.5) and gestational age < 37 weeks (RR = 11.82, 95% CI 7.46-18.71). CONCLUSIONS This study found a low rate of UR compared with other European countries, probably due to the high rate of primary caesarean sections and to resistance towards trial of labour and vaginal delivery after caesarean section among obstetricians in Italy. The unforeseen increase in caesarean sections -and, as a result, an increase in placenta accreta spectrum disorders, peripartum hysterectomy and related maternal and perinatal morbidity and mortality as a consequence of previous uterine scarring - failed to ensure better maternal and perinatal outcomes.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | | | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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Abstract
In this commentary, we discuss the associations between adenomyosis, fertility, and obstetric outcomes. A recent meta-analysis on the impact of adenomyosis on reproductive outcomes found a 43% reduction in the odds ratio (OR) for clinical pregnancy and a threefold increase in the risk of miscarriage in women with adenomyosis compared with controls. Moreover, adenomyosis seems to be strongly associated with pre-eclampsia with an OR of almost 8. Also, the risk for small for gestational age was almost fourfold increased, whereas for preterm deliveries was threefold increased. The presence of deep infiltrating endometriosis and adenomyosis seems associated with particularly adverse obstetric outcomes, especially concerning natural conception. Some observations suggest that the probability of clinical pregnancy is considerably low in these cases, around 11.8%. Although several methodological drawbacks prevent definitive conclusions, all these elements should be considered in counseling women with adenomyosis seeking pregnancy, especially in cases of IVF.
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Affiliation(s)
- Laura Buggio
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy.
| | - Dhouha Dridi
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Giussy Barbara
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy.,SVSeD, Service for Sexual and Domestic Violence and Obstetric and Gynecology Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12 -, 20122, Milan, Italy
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Zamani M, Alizadeh S, Mollabashi M. Fertility-sparing uterine lesion resection in a woman with hemoperitoneum due to invasive mole: A rare case report. Int J Surg Case Rep 2021; 84:106117. [PMID: 34167070 PMCID: PMC8239455 DOI: 10.1016/j.ijscr.2021.106117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Gestational trophoblastic neoplasia comprises a unique group of human neoplastic diseases that derive from fetal trophoblastic tissues. The hydatidiform mole is the most common form of GTD, representing 80 % of cases. An invasive mole is a hydatidiform mole characterized by the enlarged hydropic villi invading into the myometrium, into vascular spaces, or into extrauterine sites. Case presentation Here is a case with invasive mole after the evacuation of complete molar pregnancy, presented with an acute abdomen. We desired to preserve the uterine because our 21 years old patient doesn't have a child. Clinical discussion An emergency abdominal ultrasound scan showed a 47 ∗ 34 ∗ 55 mm ill-defined hyperechoic heterogeneous mass with anechoic cystic vascular spaces within it, in the posterior wall of the uterus away from the endometrium that extended to the serous layer of the uterus. Laparotomy was done. After the evacuation of 2 L of hemoperitoneum, an approximately 5 × 4 metastatic, vesicular mass was seen in the posterior wall of the uterus, which was resected and uterine preservation was successful. Conclusion This case report describes the clinical, imaging, surgical and histopathological findings of Invasive mole after a hydatidiform molar pregnancy. Our case highlights the feasibility of fertility-preserving surgery in the case who experienced life-threatening hemorrhage due to a ruptured uterus. An invasive mole rarely presents as hemoperitoneum. Ultrasound scan and color flow Doppler are particularly useful for diagnosis in GTN. Fertility-preserving surgery in life-threatening hemorrhage due to a ruptured uterus is challenging.
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Affiliation(s)
- Mehrangiz Zamani
- Department of Obstetrics & Gynecology, Hamadan University of Medical Science, Hamadan, Iran
| | - Shima Alizadeh
- Obstetrician & Gynecologist, Board Certified at Tehran University of Medical Science, Tehran, Iran
| | - Mina Mollabashi
- Department of Radiology, Hamadan University of Medical Science, Hamadan, Iran.
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Wang S, Kadeer M, Yusufu R, Niu J, Liu Y, Rouzi P, Sui S, Wang J, Li X, Wang Y, Ren Y, Huang Y. Delayed stillbirth by hysterectomy following early-term uterine rupture with fetal demise in secundigravida. Radiol Case Rep 2021; 16:2081-2085. [PMID: 34158898 PMCID: PMC8203557 DOI: 10.1016/j.radcr.2021.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Uterine rupture and postterm pregnancy pose a number of life-threatening complications to both mother and child, including severe intra-abdominal bleeding and peritonitis, birth injury, hypoxia, and fetal loss. This report presents a rare case of a 20-year-old female experiencing fetal demise at 60 weeks of pregnancy, with uterine rupture and bone tissue discharge from her vagina without severe intra-abdominal bleeding and peritonitis. The mild clinical course despite complete uterine rupture was due to the firm adhesion of the amniotic sac to the uterus caused by inflammation. The adhesion of the intestines to the rupture site prevented dehiscence of the ruptured wound. Suppuration and bone tissue discharge relieved the pressure on the patient's abdominal cavity and prevented subsequent occurrence of severe peritonitis. Radiologists mistakenly regarded the thick amniotic sac wall on the right side of the uterine wall as a right cornual pregnancy with uterine rupture caused by chronic inflammation. This report aims to bring awareness of this rare condition to medical students and radiologists.
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Affiliation(s)
- Shanshan Wang
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Muhetaerjiang Kadeer
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Rouzi Yusufu
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Junqiao Niu
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Yan Liu
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Patiman Rouzi
- Department of Obstetrics and Gynecology in hospital of Urumqi Friendship hospital, Xinjiang Uygur Autonomous Region
| | - Shuang Sui
- Department of Obstetrics in hospital of Xinjiang Uygur Autonomous Region
| | - Jia Wang
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Xiaojuan Li
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Yan Wang
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Yongfang Ren
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Ying Huang
- Department of Obstetrics in hospital of Xinjiang Uygur Autonomous Region
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