Complete rupture of the pregnant uterus: A 12-year retrospective study.

OBJECTIVE: To assess the frequency of uterine ruptures, clinical characteristics, and maternal and neonatal outcomes in a tertiary referral center. METHODS: Information on complete uterine rupture between July 2010 and June 2022 was investigated retrospectively at a tertiary center. RESULTS: There were 42 cases of complete uterine rupture in 144 474 deliveries, with an incidence rate of 0.029%. Twenty-seven cases had a scarred uterus and 15 had an unscarred uterus; Rupture of the lower uterine segment was predominant in the scarred uterus, whereas rupture of the body of the uterus was predominant in the non-scarred uterus (P ≤ 0.001). Newborns with Apgar score of 7 or less at 1 min in the non-scarred uterus group was more than that in the scarred uterus group (P = 0.001). There were no significant differences in the history of gynecologic surgery, induction of labor, mode of delivery, clinical features, maternal outcomes, neonatal weight, preterm birth rate, 5-min Apgar score, or neonatal mortality between the two groups (P > 0.05). CONCLUSION: The clinical manifestations of uterine rupture are mainly abdominal pain, abnormal fetal heartbeat, or vaginal bleeding. Attention should also be paid to the history of previous uterine surgery. Strict prenatal management, early identification, and aggressive management can help improve maternal and child outcomes. Hysterectomy is not imperative.

Labisia pumila as a Culprit of Primary Uterine Rupture Alongside Abruptio Placentae: A Case Report.

Purpose: Uterine rupture is a rare obstetrical and surgical emergency but is often associated with a catastrophic obstetric complication. Traditionally, unscarred uteri without risk factors are considered immune to rupture and information about its risk factors is only few due to its rarity. Complementary and alternative medicine is commonly used in pregnant woman in southeast Asian countries such as Indonesia, however information regarding its toxicity due to irrational use is few. This case report presents a G2P1A0 35-year-old woman with acute abdomen with spontaneous unscarred uterine rupture >15 cm after continuously consuming herbal water made of Kacip Fatimah leaves in boiling water. Case Description: A 35-year-old pregnant woman was referred to hospital due to abdominal discomfort 3 hours before admission due to suspicion of intrauterine fetal death. She drank the extracted herbal water to help her when the labor comes, which was made from boiled water with rumput Fatimah from her neighbor's house. Then, she was diagnosed with G2P1A0 parturient aterm latent phase; acute abdomen due to suspicion of placentae abruption dd/ ruptur uteri; and Intrauterine Fetal Death. Exploratory laparotomy was decided due to acute abdominal pain, and during the procedure the operator decided to do subtotal hysterectomy on the patient. The operator found her uterine was already ruptured, approximately 15-18 cm and the placentae was located outside of the uterus. Conclusion: This case suggest that rational usage of herbal medicine must be implemented to avoid unwanted complication.

Spontaneous fundal rupture in an unscarred uterus in a female with twin pregnancy after in-vitro fertilization: a case report.

Spontaneous uterine rupture in an unscarred uterus is very rare. It is found to be rarer after in-vitro fertilization. It is associated with significant morbidity and mortality if not diagnosed and treated promptly. Case presentation: Thirty three years female with twin pregnancy following in-vitro fertilization after 11 years of marriage presented to emergency department with lower abdominal pain at 36 weeks 3 days of gestation and was planned for emergency caesarean section for precious twin pregnancy in labour. Clinical findings and investigation: She was vitally stable and on palpation of abdomen, there was generalized tenderness along with guarding. All the investigations were within normal limits. Intervention and outcome: Emergency caesarean section was performed under subarachnoid block which revealed a 6×2 cm fundal uterine rupture with no active bleeding which was repaired in layers. The babies were extracted with a lower uterine segment incision. First twin cried immediately after birth while the second one needed resuscitation and mechanical ventilation due to perinatal asphyxia. Conclusion: Even though rare in a previously unscarred uterus, uterine rupture can present in different forms and thus, requires vigilant evaluation of the patient and prompt intervention to avoid significant maternal or foetal morbidity and mortality.

Generalized Peritonitis Secondary to Perforated Uterine Pyometra.

Generalized peritonitis with sepsis is a common general surgery emergency. The most likely implicated structure for generalized peritonitis with pneumoperitoneum is the gastrointestinal tract with urgent explorative laparotomy being the most definitive treatment. In this particular case, perforated diverticulitis was suspected and upon an exploration of the abdomen, frank pus in the setting of normal colon was noted. Some common differential diagnoses for frank pus in the abdomen include viscus perforation, pancreatic necrosis, gangrenous cholecystitis, or penetrating abdominal trauma. Here, we report a rare occurrence of peritonitis secondary to uterine rupture from pyometra.

Spontaneous Uterine Rupture and Adenomyosis, a Rare but Possible Correlation: Case Report and Literature Review.

(1) Background: Uterine rupture during pregnancy is a serious obstetric complication with a high incidence of maternal morbidity and mortality. (2) Methods: The present case is a rare event of a uterine rupture occurring in an unscarred uterus in a nonlaboring primigravida woman in the second trimester. The only risk factor in this case was adenomyosis found in the preconceptional phase. (3) Results: The diagnosis of adenomyosis can often be difficult, so patients should be evaluated by a specialized gynecologist. After careful amnestic collection, a gynecological examination and II level ultrasound should be performed in accordance with the Morphological Uterus Sonographic Assessment classification. (4) Conclusions: This evaluation allows us to identify classes of patients at high risk of uterine rupture who, therefore, must be properly informed of the risks both during preconceptional counseling and during pregnancy.

Concealed Uterine Rupture in the Broad Ligament in an Unscarred Uterus With Postpartum Hemorrhage.

Uterine rupture is an obstetric emergency that traditionally occurs during delivery in a mother with previously known risk factors, especially a uterine scar. However, a rupture that occurs in an unscarred uterus is uncommon. We report a case of a low-risk mother who presented for induction of labor for late-term pregnancy, without a history of uterine surgery, required vacuum-assisted vaginal delivery for maternal exhaustion, and one hour later was noted to have postpartum hemorrhage. The postpartum hemorrhage was managed medically but was taken for curettage due to continued hemorrhage and hemodynamic instability, followed by laparotomy which identified an 11 cm vertical uterine rupture parallel to the ascending uterine artery concealed in the broad ligament and extending inferiorly to the lateral cervix, necessitating a total abdominal hysterectomy. The patient tolerated the procedures well and was discharged home on postoperative day 2. Highlighting the importance of a high index of suspicion for uterine rupture, even without risk factors, this report describes an atypical presentation and describes an effective stepwise approach to management.

Complete Rupture of the Pregnant Uterus: A 10-year Retrospective Descriptive Study.

OBJECTIVE: The goal of this work is to analyze the incidence, etiology, clinical characteristics, maternal and neonatal outcomes of complete uterine rupture during pregnancy. METHODS: The information of complete uterine rupture between June 2010 and May 2020 was investigated retrospectively at a tertiary center, and included demographic data, delivery characteristics, intraoperative findings, and maternal and neonatal outcomes. The prevalence rate of uterine rupture in the early group (hospitalized from June 2010 to May 2015) and late group (June 2015 to May 2020) was compared and analyzed. RESULTS: There were 37 (0.056%) cases of complete uterine rupture in 66 092 births, including 27 (0.041%) of scar uterus and 10 (0.015%) of non-scarred uterus. High-risk factors for scarred uterine rupture included: previous cesarean section (13, 48.1%), myomectomy (8, 29.6%), corneal pregnancy resection (6, 22.2%), history of uterine rupture (1, 3.7%), and uterus perforation during abortion (1, 3.7%). Compared to the early group, the number of uterine ruptures caused by previous cesarean section was significantly reduced in the late group. Of the 10 patients with non-scarred uterine rupture, 3 (30%) occurred during delivery and 7 (70%) were spontaneous. Among the 37 complete rupture patients, 3 (8.1%) died of uterine scar rupture, 19 (51.3%) cases were reported with fetal/newborn deaths, 5 (13.5%) cases underwent hysterectomy and the rest were treated with uterine repair. CONCLUSION: Complete uterine rupture often has catastrophic effect on pregnancy outcomes. Obstetrics doctors should be vigilant to identify the risk factors and clinical presentations of uterine rupture during pregnancy. Strict prenatal management is beneficial to improve pregnancy outcomes.

Spontaneous unscarred uterine rupture in a primigravid patient at 11 weeks of gestation managed surgically: A rare case report.

INTRODUCTION: Spontaneous rupture of the primigravid uterus is a rare but catastrophic obstetrical emergency. It usually occurs late in pregnancy or during labour, mainly in multiparous women. But, spontaneous unscarred uterine rupture in a primigravid patient that also in first trimester is very rare. There are only 12 papers in Pub Med database regarding spontaneous unscarred uterine rupture in primigravid in early pregnancy. CASE PRESENTATION: A 23-year-old primigravid female at 11th week of pregnancy, with no significant medical or surgical history, presented with sudden onset of generalised abdominal pain for four hours with multiple episodes of vomiting. On physical examination, patient was pale, in haemorrhagic shock with diffuse abdominal tenderness. Ultrasonography showed extra uterine gestational sac with massive haemoperitoneum. Eventually, patient was subjected to emergency laparotomy after resuscitation. CLINICAL DISCUSSION: Spontaneous rupture of unscarred gravid uterus is a catastrophic rare condition that can be missed leading to maternal and foetal mortality. There are no pathognomonic features indicating the condition therefore it should be differentiated from other causes of acute abdominal emergencies. CONCLUSION: Spontaneous rupture of unscarred gravid uterus should be differentiated from other acute abdominal emergencies. Patient may land up in emergency department in the state of shock, emergency physicians should be aware of its symptoms or presentations.

Second trimester rupture uterus, unusual presentation.

INTRODUCTION: Spontaneous uterine rupture before onset of labour is extremely rare. This is even more so in the second trimester of pregnancy, in nulliparous women and in the absence of myometrial surgery. The initial presentation of this potentially catastrophic event may be non-specific, with upper or lower abdominal discomfort, vague gastrointestinal or urinary symptoms preceding rapid deterioration. DISCUSSION: This case report demonstrates that a high index of suspicion, rapid diagnosis aided by imaging modalities and immediate surgical intervention are crucial steps in successful management. A postulated etiology in our patient is that of an upper scar from a previous uterine curettage with abnormal placentation predisposing to spontaneous rupture. PRESENTATION OF CASE: A case of spontaneous uterine rupture at 16 week's gestation in a multiparous, 32 year old patient with no history of myometrial surgery. She had presented with lower abdominal discomfort, progressing to severe pain with hypotension and tachycardia. An urgent ultrasound pelvis showed a live fetus, free intra-peritoneal fluid with blood clots. An emergency laparotomy performed revealed 2 L of hemoperitoneum, with the fetus intact in the amniotic sac. The uterine fundal rupture was successfully repaired. CONCLUSION: Despite the gestation, in women presenting with symptoms and signs suggestive of acute abdomen and hemodynamic instability, prompt resuscitation must be instituted, and a high index of suspicion for rupture must be suspected.

Spontaneous uterine rupture and surgical repair at 21 weeks gestation with progression to live birth: a case report.

BACKGROUND: Uterine rupture in the non-laboring uterus is a rare occurrence, which can lead to significant morbidity and mortality for the mother and fetus. Management of this presentation is complex at pre-viable gestations. CASE PRESENTATION: A 35 year old primigravid woman with multiple previous myomectomies presented with spontaneous complete thickness uterine rupture at 21 weeks gestation. A 10 cm myometrial defect and iatrogenic amniotomy were surgically corrected with fetal preservation. This led to pregnancy continuation to 32 weeks gestation when elective cesarean delivery resulted in excellent neonatal outcome. CONCLUSIONS: Early surgical diagnosis, multidisciplinary team approach, iatrogenic amniotomy and continuous two-layer myometrial closure were factors that contributed to pregnancy prolongation in this large myometrial rupture.

Escalating placenta invasiveness: repeated placenta accreta at the limit of viability.

Placenta percreta is an obstetric condition in which the placenta invades through the myometrium. This is the most severe form of placenta accreta and may result in spontaneous uterine rupture, a rare complication that threatens the life of both mother and fetus. In this case report, we describe a 32-year-old woman in her fourth pregnancy, diagnosed with repeated placenta accreta, which was eventually complicated by spontaneous uterine rupture at 24 weeks' gestation. This patient had a history of abnormal placentation in prior pregnancies and previous uterine injuries. This case demonstrates a pattern of escalating placental invasiveness, and raises questions regarding the process of abnormal placentation and the manifestation of uterine rupture in scarred uteri.

Amniotic Sac Herniation Through a Prior Cornual Scar in The Third Trimester.

Introduction Uterine rupture occurs in less than 0.1% of pregnancies. This complication can be detrimental to mother and fetus if not detected and managed in a timely manner. We report an unusual presentation of uterine scar rupture that was diagnosed on ultrasound in a completely stable patient with reassuring fetal status. Case Report A 24-year-old Gravida 5, Para 3 with history of cornual resection for ectopic pregnancy and two previous uterine ruptures presented at 30 weeks' gestation with worsening abdominal pain. Ultrasound identified herniation of the amniotic sac with fetal parts. The patient underwent cesarean delivery and cornual defect repair. Conclusion Close observation and early delivery remain vital to the patient's management.

A Case of Spontaneous Uterine Rupture of the Unscarred Uterus in 14 Weeks Gestation / 영남의대학술지

Spontaneous uterine rupture of the unscarred uterus during the second trimester of pregnancy is rare, but it is a surgical emergency. Because it results in rapid deterioration of patient and high mortality despite of prompt operation and massive transfusion, early diagnosis and proper management are critical for optimizing patient care. We present a case of spontaneous uterine rupture with fetal death in 14 weeks gestation with a brief review of literatures.

A Case of Uterine Rupture in the 18th Week of Pregnancy / 대한산부인과학회잡지

Spontaneous uterine rupture during the second trimester of pregnancy is a rare obstetric emergency. When a patient presents with acute abdominal pain and signs of hemorrhagic shock, a number of differential diagnoses must be considered. Early diagnosis and proper management is necessary to decreased the high maternal and fetal morbidity and mortality associated with rupture of uterus. We present a case of spontaneous rupture of the uterus in the 18th week of pregnancy with a brief review of literatures.

A Case of Spontaneous Uterine Rupture in the Second Trimester of Pregnancy

Uterine rupture in the second trimester is rare, but it is a surgical emergency. Also it results rapid deterioration of patient and high mortality despite of prompt therapy and massive transfusion. Radiologic studies often do not allow definitive diagnosis of it, so clinical judgement is critical for optimizing patient care. We present a case of spontaneous uterine rupture with fetal death in 17 weeks of pregnancy due to placenta percreta with brief review of the literature.