Rotura uterina espontánea en el primer trimestre del embarazo / Uterine rupture spontaneously in the first quarter of pregnancy

RESUMEN

La rotura uterina es una complicación obstétrica infrecuente, pero potencialmente letal para la madre y el feto. Ocurre principalmente durante el segundo o tercer trimestre, asociada a factores de riesgo, entre los que destaca la cirugía uterina previa. Su aparición durante el primer trimestre es excepcional, constituyendo un desafío médico por su difícil diagnóstico diferencial y controversial manejo. Se presenta el caso de una paciente con rotura espontánea de útero grávido de 10 semanas de gestación, portadora de triple cicatriz anterior. El diagnóstico fue intraoperatorio, tras la descompensación hemodinámica de la paciente. El manejo incluyó el cierre primario de la lesión y observación posterior. Al sexto día se constata la muerte fetal y se efectúa el vaciamiento de la cavidad uterina. La falla de las medidas conservadoras obligó finalmente a realizar una histerectomía obstétrica. La histopatología informó placenta acreta.

ABSTRACT

Uterine rupture is an uncommon obstetric event, but still potentially lethal for the mother and the fetus. It presents mainly during the second or third trimester and is associated with several riskf actors, being a previous uterine scar the most important of them. Its presentation during the first trimester is exceptional, and it constitutes a medical challenge, because of its difficult differential diagnosis and controversial management. A case of a multiparous, previous triple scar woman is presented, with a spontaneous uterine rupture at 10 weeks of pregnancy. In this case the diagnosis was made during surgery, after the patient's hemodynamic decompensation. The management included primary closure of the lesion and observation; when fetal death was confirmed, dilatation and curettage of the cavity had to be performed. Because of the failure of conservative management, an obstetric hysterectomy was carried out. Histopathology reported placenta accreta.