Silent Spontaneous Uterine Rupture at 36 Weeks of Gestation

Introduction.Silent spontaneous rupture of the uterus before term, with extrusion of an intact amniotic sac and delivery of a healthy neonate, with no maternal or neonatal morbidity or mortality is very rare. Very few cases have been reported in literature.Case Presentation.We report a case of silent spontaneous uterine rupture, found during a scheduled repeat cesarean section at 36 weeks of gestation. Patient had history of two prior classical cesarean sections. She underwent cesarean section, with delivery of a healthy male infant. She had a good postoperative recovery and was discharged on postoperative day 3.Conclusion.Silent spontaneous rupture of the uterus before term with extrusion of an intact amniotic sac is rare. A high index of suspicion and good imaging during pregnancy are important in making this diagnosis.

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A CASE OF SILENT SPONTANEOUS UTERINE RUPTURE AT 27-28 WEEKS OF GESTATION, TWO PRIOR C- SECTIONS AND HISTORY OF UTERINE RUPTURE

Jurnal Kedokteran Syiah Kuala ◽

10.24815/jks.v18i1.11213 ◽

2018 ◽

Vol 18 (1) ◽

Author(s):

Lutfi, M.D. ◽

Tengku Puspa Dewi

Keyword(s):

Uterine Rupture ◽

Spontaneous Rupture ◽

Hypovolemic Shock ◽

Postoperative Recovery ◽

Base Line ◽

Second Trimester ◽

Spontaneous Uterine Rupture ◽

Risk Of Rupture ◽

History Of ◽

High Index Of Suspicion

Introduction.Silent spontaneous rupture of the uterus at the second trimester of gestation was very rare. In this case was accompaniedby extrusion of an intact amniotic sac and normal fetal heart rate base line. Silent uterine rupture can be very difficult to diagnose, as the clinical features of uterine rupture, including abdominal pain, vaginal bleeding, maternal hypovolemic shock or hemorrhage, may be absent.Very few cases have been reported in literature.CasePresentation.Wereport a case of silent spontaneous uterine ruptureat 27-28 Weeks of Gestation.Patient had history of two prior cesarean sections with the last C-sections has uterine rupture. The residents were misdiagnosis silent spontaneous rupture with condition of dyspepsia. She underwent cesarean subtotal hysterectomy and deliveredalive infant. She had a good postoperative recovery and was discharged on postoperative day 3. Conclusion.Silent spontaneous rupture of the uterus at second trimester of gestation with extrusion of an intact amniotic sac is rare.For this case even there were no sign of acute abdomen and shock but only sign of dyspepsia. We have to think about the risk of Rupture uterine imminens. A high index of suspicion and good imagingduring pregnancy are important in making this diagnosis. Keywords: uterine rupture, dyspepsia, cesareanhysterectomy

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Placenta Percreta: An Unusual Etiology for Spontaneous Rupture of Uterus Near Term

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1303 ◽

2014 ◽

Vol 6 (3) ◽

pp. 180-182

Author(s):

Anupam Varshney ◽

Neerja LNU ◽

Manju Varma ◽

RK Thakral

Keyword(s):

Pregnant Women ◽

Uterine Rupture ◽

Spontaneous Rupture ◽

Placenta Percreta ◽

Emergency Laparotomy ◽

Lower Segment Cesarean Section ◽

Spontaneous Uterine Rupture ◽

History Of ◽

Rupture Of Uterus ◽

Near Term

ABSTRACT Uterine rupture is a life-threatening complication in pregnancy with an incidence of 0.07%, out of which 80% are spontaneous rupture. Placenta percreta is the rarest form of placental implantation abnormalities, with an incidence 1 in 2500 pregnant women.1,2 Spontaneous uterine rupture due to placenta percreta is very rare, with an incidence of 1 in 4,366 pregnant women.3 It often occurs in patients with a history of scar in the uterus.4 Placenta percreta-induced spontaneous uterine rupture at term with previous lower segment cesarean section (LSCS) is difficult to diagnose. A 25-year-old pregnant woman, with history of one incomplete abortion treated by dilatation and curettage followed by a vaginal delivery with stillbirth and one LSCS again with stillbirth at term, was admitted in the emergency ward with history of approx 9 months amenorrhea, breathlessness, pain in abdomen (unable to lie down or even sit), vomiting and loss of fetal movements for last 24 hours. O/E: GC fair, afebrile, Pallor +++, pedal edema +, pulse 100/minutes regular, resp. rate; 40/minutes, thoracic, BP 110/70 mm Hg, lung fields clear with no abnormality detected in heart. On P/A: skin was stretched and a Pfannensteil scar healed by primary intention was present Abdomen tense, tender therefore fundal height could not be assessed. Fetal parts were not palpable and lie/presentation could not be made out. FHS were absent. On P/V; os closed with uneffaced cervix, presenting part could not be made out and was high. No bleeding or leaking per-vaginum was present. Hb 6.7 gm%, TLC 15600, DLC P90, L8, E2, M0. Ultrasound done on 27.5.12 (one month back) outside revealed 32.3 weeks gestation with normal scar thickness, placenta located in upper segment, grade I. No comment was made on the interface between placenta and myometrium in ultrasound report. Patient was subjected to emergency laparotomy, massive hemoperitoneum was found. Examination of uterus revealed an intact previous scar. A full term male stillborn baby was delivered by uterine scar (LSCS) on 21.6.2012, at 10.30 pm The placenta could not be delivered as there was no plain of cleavage between placenta and myometrium. Uterus was exteriorized and to surprise there was a rent of about 3 × 2 cm at left cornua, placental tissue peeping out on removing the clots. Subtotal hysterectomy was performed. Three units blood were transfused. Postoperative period was uneventful and the patient was discharged in satisfactory condition on 9th day. Histopathological examination of the uterine specimen revealed placenta percreta. To conclude uterine rupture should be considered in the differential diagnosis in pregnant women who present with acute abdomen with or without shock. How to cite this article Neerja, Varma M, Thakral RK, Varshney A. Placenta Percreta: An Unusual Etiology for Spontaneous Rupture of Uterus Near Term. J South Asian Feder Obst Gynae 2014;6(3):180-182.

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Spontaneous uterine rupture of an unscarred uterus in primigravida: case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201261 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1750

Author(s):

Minakshi D. Bansode

Keyword(s):

Uterine Rupture ◽

Spontaneous Rupture ◽

Anterior Wall ◽

Postoperative Recovery ◽

Lower Margin ◽

Spontaneous Uterine Rupture ◽

Maternal Morbidity And Mortality ◽

Primigravid Woman ◽

Operative Findings ◽

The Right

A spontaneous rupture of the unscarred uterus in a primigravid patient is extremely rare and is associated with high perinatal and maternal morbidity and mortality. Study report a case of spontaneous rupture of an unscarred uterus at 36 weeks of gestation in a 22-years primigravid woman. Ultrasonography showed posterior low-lying placenta praevia with lower margin touching internal OS. Operative findings during emergent caesarean section revealed e/o 2 L of hemoperitoneum, uterus was bicornuate and pregnancy was in the right horn. There was fundal rupture of right horn measuring approximately 6-7 cm anteroposterior. Incision was taken on the lower part of right horn and placenta was seen on anterior wall. Baby delivered as breech after incising placenta. Postoperative recovery was uneventful. In, conclusion, bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid patients and at any gestation.

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Spontaneous Uterine Rupture in a Preterm Pregnancy following Myomectomy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/6195621 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Claire Sutton ◽

Prue Standen ◽

Jade Acton ◽

Christopher Griffin

Keyword(s):

Abdominal Pain ◽

Caesarean Section ◽

Uterine Rupture ◽

Good Condition ◽

Acute Onset ◽

Uterine Wall ◽

Unusual Presentation ◽

Postoperative Course ◽

Spontaneous Uterine Rupture ◽

History Of

A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm. The neonate was transferred to the Special Care Nursery for neonatal care. The patient had an uncomplicated postoperative course and was discharged home three days following delivery. This is an unusual presentation of uterine rupture following myomectomy where the fetal arm had protruded through the uterine wall.

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Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

10.21203/rs.3.rs-27382/v3 ◽

2020 ◽

Author(s):

Se Jin Lee ◽

Hyun Sun Ko ◽

Sunghun Na ◽

Jin Young Bae ◽

Won Joon Seong ◽

...

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Uterine Rupture ◽

Placenta Previa ◽

Multivariate Logistic Regression Analysis ◽

Population Based ◽

Obstetric Outcomes ◽

Nulliparous Women ◽

History Of ◽

Adverse Pregnancy

Abstract Background: Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy. Methods: We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis. Results: During the study period, 38,402 women with diagnosed myoma(s), 9,890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16 and aOR 7.46, 95% CI 6.97-7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54 and aOR 1.58, 95% CI 1.35-1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5-25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18-105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy. Conclusions: Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.

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Ceasarean scar pregnancies, diagnosis and management

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181361 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1592

Author(s):

Atmajit Singh Dhillon ◽

Sandeep Sood

Keyword(s):

Cesarean Section ◽

Care Service ◽

Tertiary Care ◽

Expectant Management ◽

Transvaginal Sonography ◽

Colour Doppler ◽

History Of ◽

Gestational Sac ◽

Uterine Scar ◽

High Index Of Suspicion

Background: Objective of present study was to describe evaluation and management of pregnancies implanted into uterine Cesarean section scars, Ceasarean scar pregnancies (CSP), is defined as gestational sac implanted in the myometrium at the site of a previous ceasarean scar. Also known as Ceasarean ectopic pregnancy.Methods: In all antenatal patients attending the antenatal outpatient department of a tertiary care service hospital a transvaginal sonography was done for determining the gestational age as well as the viability of the pregnancy. In all patients with a history of previous Cesarean section(s), special effort was made to assess the possibility of implantation into the uterine scar by means of an early transvaginal and colour doppler ultrasound.Results: Twelve Cesarean section scar pregnancies were diagnosed in a five-year period, of a tertiary care service hospital. Five (42%) patients with Cesarean scar pregnancies were treated surgically, four patients medically (33%), and two patients expectantly (17%) and one patient opted to continue the pregnancy. Surgical management was successful in all cases, although two of five (40%) women suffered bleeding (300-500ml). In the group of women who were managed medically the success rate was 3/4(75%). Expectant management was successful in one of two cases (50%). One patient who opted to continue pregnancy, underwent a ceasarean hysterectomy at 33 weeks of gestation for placenta accreta.Conclusions: Incidence of ceasarean section scar pregnancies is increasing as is the increasing rate of ceasarean deliveries. A high index of suspicion in all cases of post ceasarean pregnancies, coupled with early transvaginal ultrasonography along with colour doppler confirmation and institution of early and individualized treatment, optimizes the clinical outcome. Although rare, the patient and her relatives must be made aware of the possibility of recurrent CSP.

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Spontaneous Uterine Rupture at 15 Weeks' Gestation in a Patient with a History of Cesarean Delivery after Removal of Shirodkar Cerclage

American Journal of Perinatology Reports ◽

10.1055/s-0033-1358767 ◽

2013 ◽

Vol 4 (01) ◽

pp. 001-004 ◽

Cited By ~ 5

Author(s):

Serika Kanao ◽

Hirotsugu Fukuda ◽

Mayuko Miyamoto ◽

Eriko Marumoto ◽

Kiichiro Furuya ◽

...

Keyword(s):

Cesarean Delivery ◽

Uterine Rupture ◽

Spontaneous Uterine Rupture ◽

History Of

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A case series of uterine rupture: a continuing cause of maternal and fetal morbidity!

International Surgery Journal ◽

10.18203/2349-2902.isj20172775 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2247

Author(s):

Vinu Choudhary ◽

Surendra Bisu

Keyword(s):

Risk Factors ◽

Uterine Rupture ◽

Spontaneous Rupture ◽

Case Series ◽

Neonatal Morbidity ◽

Uterine Wall ◽

Full Thickness ◽

Increased Risk ◽

Associated Risk Factors ◽

Ruptured Uterus

Background: Uterine rupture is defined as a full-thickness separation of the uterine wall and the overlying serosa. It is a rare peripartum complication associated with severe maternal and neonatal morbidity and mortality. The objective of this study was to review the incidence of ruptured uterus and evaluate associated risk factors, maternal and fetal complications.Methods: 14 case notes were reviewed for every patient with a ruptured uterus for a period of 4 years, from January 2012 to December 2015.Results: 79% patients had uterine rupture while in labour. Three patients were not in labour (two had a spontaneous rupture at 28/40 and 33/40 weeks respectively and for one patient it was found during an elective C/S). Two out of five patients with 2 previous C/S ruptured at 28 and 33 weeks respectively. Two or more C/S were associated with increased risk of pre- labour rupture uterus as highlighted by the three cases.Conclusions: Challenging diagnosis and cases of pre- labour rupture may necessitate pre- pregnancy counselling and antenatal LUS thickness USS in certain cases.

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Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

10.21203/rs.3.rs-27382/v2 ◽

2020 ◽

Author(s):

Se Jin Lee ◽

Hyun Sun Ko ◽

Sunghun Na ◽

Jin Young Bae ◽

Won Joon Seong ◽

...

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Uterine Rupture ◽

Placenta Previa ◽

Multivariate Logistic Regression Analysis ◽

Population Based ◽

Obstetric Outcomes ◽

Nulliparous Women ◽

History Of ◽

Adverse Pregnancy

Abstract Background: Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.Methods: We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis.Results: During the study period, 38,402 women with diagnosed myoma(s), 9,890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16 and aOR 7.46, 95% CI 6.97-7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54 and aOR 1.58, 95% CI 1.35-1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5-25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18-105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy. Conclusions: Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.

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