Spontaneous combined bladder and uterine rupture in pregnancy

Introduction: Wunderlich’s syndrome (WS), characterized by non-traumatic renal haemorrhage into the subscapular and perinephric space is a rare entity in pregnancy. Aim: This article highlights the incidental discovery of a pregnant woman with WS that resulted in emergency nephrectomy. Case study: A 31-year-old gravida 4 para 3 female with 3 previous caesarean sections presented with acute abdomen and was in shock. The abdominal ultrasound revealed gross haemoperitoneum. With the preoperative diagnosis of a uterine rupture, surgical exploration was done showing an extensive right perinephric hematoma and active bleeding from the renal hilum. No renal tumor or pseudoaneurysm of the renal hilum was noted. Emergency nephrectomy was performed. Unfortunately, the foetus did not survive the ordeal. Results and discussion: WS occurs as a result of renal neoplasms, idiopathic causes, vascular diseases, infection, and miscellaneous. Ultrasonography can help to identify the perinephric hematoma, meanwhile, colour and/or spectral Doppler can aid in the detection of vascular pathologies. Contrast-enhanced computed tomography is still the imaging modality of choice. In pregnancy, a magnetic resonance imaging would be a better modality, avoiding radiation exposure to the foetus and consequent foetal malformations. Treatment includes arterial embolization and/or operative management such as nephrectomy. Conclusions: WS in pregnancy is a rare clinical entity requiring a high index of clinical suspicion for diagnosis. WS needs to be considered in pregnant patients presenting with shock with the presence of perinephric hematoma. A multidisciplinary approach is essential in providing optimum care.

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Analysis of Uterine Rupture in Pregnancy at a Tertiary Care Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v14i1.26623 ◽

2019 ◽

Vol 14 (1) ◽

pp. 29-31

Author(s):

Beemba Shakya

Keyword(s):

Maternal Mortality ◽

Uterine Rupture ◽

Perinatal Death ◽

Tertiary Care ◽

Patient Characteristics ◽

Care Hospital ◽

Cross Sectional ◽

Peripartum Hysterectomy ◽

Neonatal Deaths ◽

In Pregnancy

Aims: To analyze patients with uterine rupture in pregnancy. Methods: This was a cross-sectional retrospective study undertaken at Paropakar Maternity and Women’s Hospital. Two years’ medical records of uterine rupture between 14 April 2017 and 13 April 2019 were reviewed. Information on patient characteristics, age, parity, mode of previous deliveries, onset of labour spontaneous or induced, type and site of rupture, maternal and perinatal outcome, management and complications associated with it were retrieved and was analyzed using SPSS version 16.0. Results: Among 29 uterine rupture cases, majority of cases occurred in 25-29 years (48.3%), para1 (79.3%) and unbooked cases (72.4%). Most of them occurred in previous scar 23(79.3%); rupture was complete in 13 and incomplete in 10 cases. Six (20.6%) were unscarred uterine rupture. Rupture repair was done in 24(82.7%) and peripartum hysterectomy (subtotal hysterectomy) in 5(17.2%) cases. The most common complications were postpartun hemorrhage (55.2%), hospital stay >7 days (55.2%), blood transfusion (48.3%) and ICU admission (41.3%). There was no maternal mortality. Perinatal death was 15 (51.7%)-13 stillbirths and 2 neonatal deaths. Conclusions: Majority of the uterine rupture occurred in previous scar (79.3%). Most of the cases underwent repair of the uterus (82.7%) and remaining were peripartum hysterectomy (17.2%). There was no maternal mortality. However, perinatal mortality occurred in 51.7%. Keywords: peripartum hysterectomies, previous scar, repair of uterus, uterine rupture.

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