Mid-trimester rupture uterus: case series

Uterine rupture is an obstetric catastrophe with significant maternal and fetal morbidity and mortality which occurs mainly in the third trimester of pregnancy or during labour, especially in previously scarred uterus. The occurrence of rupture in first and second trimester in women with unscarred uteri is quite rare. We report two cases of rupture uteri managed in our centre at 24 and 26 weeks gestation in women with unscarred uteri. First case was G3P1L1A1, 24 weeks with epigastric pain, stable vitals, epigastric tenderness, USG inconclusive, CT scan showed out pouching of amniotic sac through fundus. Laparotomy done, there was 8-9 cm fundal rupture extending between cornua, uterine repair done. Second case was G3P1L1A1 26 weeks with abdominal pain, stable vitals, corresponding fundal height, head engaged, USG revealed outpouching amniotic sac at the fundus. Laparotomy performed, there was 10 cm rent extending trans-fundal, uterine repair done. Unscarred uterine rupture, especially in early pregnancy is a rare event, posing significant difficulty in diagnosis. Uterine rupture should be first ruled out in all pregnant women presenting with acute abdomen irrespective of gestational age. Search for non-gynaecological causes can delay crucial obstetric intervention that can lead to loss of obstetric function, morbidity and mortality.

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The Effect of Preserving Pregnancy in Cervical Cancer Diagnosed During Pregnancy: A Retrospective Study

10.21203/rs.3.rs-507502/v1 ◽

2021 ◽

Author(s):

Zuoxi He ◽

Chuan Xie ◽

Xiaorong Qi ◽

Zhengjun Hu ◽

Yuedong He

Keyword(s):

Cervical Cancer ◽

Rare Event ◽

Oncologic Outcome ◽

First Trimester ◽

Second Trimester ◽

Third Trimester ◽

Delayed Treatment ◽

The Third ◽

Survival Difference ◽

Estimated Blood Loss

Abstract ObjectiveCervical cancer diagnosed during pregnancy is a rare event, and data regarding efficacy of cancer treatment during pregnancy is limited. This study aimed to assess the safety of continuation of the pregnancy for mother and fetus when concomitantly diagnosed with cervical cancer.MethodsThis study retrospectively analyzed all cervical cancer patients diagnosed while pregnant or immediately postpartum, inclusive from Jan 2010 to June 2019 at our institute. Patient clinical details and follow-up were obtained from hospital records. ResultsThe study comprised 40 patients with clinical cancer stages of ⅠA1 (1/40, 2.5%); ⅠB1 (15/40, 37.5%); IB2 (10/40, 25%); ⅡA (12/40, 30%); and ⅡB (2/40, 5%). There were 38 patients diagnosed during pregnancy, and 2 diagnosed in the postpartum period. Of the 38 patients, 17 were diagnosed in the first trimester, 13 in the second trimester, and 8 in the third trimester. Ten of 38 patients (26.3%) continued their pregnancy after learning of their diagnosis; 7 (70%) in the third trimester and 3 (30%) in the second trimester. The mean time from diagnosis to surgery in the patients who continued their pregnancy was 52.7 days, which was statistically significantly greater than the termination of pregnancy group (52.7 vs 16.3 days, P < 0.01). Notably, there was no survival difference between the 2 groups (100% vs 90.91%, P =0.54), and none of the pregnant women who ultimately died had delayed treatment due to pregnancy. Similarly, the surgical estimated blood loss and operative duration comparing the 2 groups were not significantly different. ConclusionsIn the present study, the gestational age of pregnancy at the time of initial diagnosis of cervical cancer was an important determinant in the disease management. Continuation of the pregnancy when diagnosed with cervical cancer did not affect the oncologic outcome of the mother nor increase either surgical or obstetric complications. Additionally, the use of neoadjuvant chemotherapy did not threaten the health of the fetus. These results may be useful in counseling patients facing the diagnosis of cervical cancer during pregnancy.

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Fetal Vascular Malperfusion Due To Long and Hypercoiled Umbilical Cords Resulting in Recurrent Second Trimester Pregnancy Loss: A Case Series and Literature Review

Pediatric and Developmental Pathology ◽

10.1177/1093526620962061 ◽

2020 ◽

pp. 109352662096206

Author(s):

Jonathan C Slack ◽

Theonia K Boyd

Keyword(s):

Umbilical Cord ◽

Rare Event ◽

Case Series ◽

Second Trimester ◽

Fetal Demise ◽

Flow Restriction ◽

Intrauterine Fetal Demise ◽

Increased Risk ◽

Second Trimester Pregnancy ◽

Umbilical Cords

Background Intrauterine fetal demise due to fetal vascular malperfusion in mid-gestation is a rare occurrence. Abnormally long and hypercoiled umbilical cords are associated with an increased risk of umbilical cord blood flow restriction, which in turn can result in adverse perinatal and maternal outcomes. The factors that regulate umbilical cord development, specifically umbilical cord length and coiling, are poorly understood. Methods Maternal history, along with fetal and placental findings (post-mortem, pathological, and molecular), were reviewed for a series of 3 consecutive pregnancies that ended in second trimester intrauterine fetal demise. Results All 3 umbilical cords were exceptionally long and hypercoiled, and all placentas showed evidence of high-grade fetal vascular malperfusion. At fetopsy, all 3 fetuses were developmentally normal for gestational age and lacked congenital anomalies. Maternal medical history and antenatal testing (including an extensive work-up for maternal hypercoagulability syndromes) were normal and/or noncontributory. Conclusion Although excessively long and hypercoiled cords are generally thought of as sporadic, nongenetic events, rare examples of recurrent intrauterine fetal demise secondary to such exist have been reported. This intrafamilial clustering of a rare event is suggestive that at least a subset of hypercoiled, long umbilical cords may have an underlying genetic etiology.

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Unexplained Spontaneous Complete Uterine Rupture in the Second Trimester: A Rare Event. Case Report and Literature Review

Journal of Gynecologic Surgery ◽

10.1089/gyn.2012.0017 ◽

2014 ◽

Vol 30 (2) ◽

pp. 108-110

Author(s):

Reetu Hooda ◽

Anjali Gupta ◽

Nirmala Duhan ◽

Daya Sirohiwal ◽

Hemant More

Keyword(s):

Case Report ◽

Literature Review ◽

Uterine Rupture ◽

Rare Event ◽

Second Trimester

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A rare case of placenta percreta causing uterine rupture and massive haemoperitoneum in 2nd trimester: an obvious near miss

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212201 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2495

Author(s):

Chirayu Parmar ◽

Mittal Parmar ◽

Gayatri Desai

Keyword(s):

Uterine Rupture ◽

Placenta Accreta ◽

Hypovolemic Shock ◽

Placenta Percreta ◽

Near Miss ◽

Second Trimester ◽

Rare Occurrence ◽

Third Trimester ◽

Placenta Accreta Spectrum ◽

Ruptured Uterus

Placenta accreta spectrum is very rarely encountered with ruptured uterus and is commonly seen in third trimester of pregnancy. Hereby, a case of placenta percreta with uterine rupture in second trimester of pregnancy is presented. 40 year old women with previous 2 LSCS presented in emergency department with ninteen weeks pregnancy and massive haemoperitoneum. Emergency laprotomy revealed uterine rupture alnong with placenta percreta for which obstetric hysterectomy was done. Although, a rare occurrence, obstetricians should consider patients placenta accreta spectrum in patients with previous surgeries presenting with haemoperitoneum and signs of hypovolemic shock in second trimester of pregnancy, considering the possibility of rupture at the site of placenta adherance.

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Incidence and contributing factors for uterine rupture in patients undergoing second trimester termination of pregnancy in a large tertiary hospital - a 10-year case series

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.05.016 ◽

2018 ◽

Vol 227 ◽

pp. 8-12 ◽

Cited By ~ 3

Author(s):

Koh Daniel Seow Choon ◽

Tan Eek Chaw ◽

Qi Lau Hester Chang Qi ◽

NG Mor Jack ◽

Tay Wan Shi ◽

...

Keyword(s):

Uterine Rupture ◽

Case Series ◽

Tertiary Hospital ◽

Termination Of Pregnancy ◽

Second Trimester ◽

Contributing Factors

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Third-Trimester Uterine Rupture without Previous Cesarean: A Case Series and Review of the Literature

American Journal of Perinatology ◽

10.1055/s-0029-1223287 ◽

2009 ◽

Vol 26 (10) ◽

pp. 739-744 ◽

Cited By ~ 34

Author(s):

Margaret Dow ◽

Joseph Wax ◽

Michael Pinette ◽

Jacquelyn Blackstone ◽

Angelina Cartin

Keyword(s):

Uterine Rupture ◽

Case Series ◽

Review Of The Literature ◽

Third Trimester ◽

Previous Cesarean

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Second trimester rupture of an unscarred uterus following blunt trauma: a case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184173 ◽

2018 ◽

Vol 7 (10) ◽

pp. 4305

Author(s):

Basil Mathews ◽

Chitra T.

Keyword(s):

Blood Transfusion ◽

Acute Abdomen ◽

Blunt Trauma ◽

Uterine Rupture ◽

Third Trimester ◽

Increased Risk ◽

Life Threatening ◽

History Of ◽

Rupture Of Uterus ◽

Scarred Uterus

Uterine rupture is a life-threatening emergency in obstetrics carrying an increased risk of maternal and foetal morbidity and mortality. Often, uterus ruptures during labour; however, scarred uterus may rupture before the onset of contractions in the late third trimester. Uterine rupture in an unscarred uterus occurs extremely rare. Various aetiology has been described in literature from anomalous uterus, uterine manoeuvres, and abnormal placentation to congenital exposure to Diethylstilbestrol. Maternal outcome depends greatly on the early diagnosis, prompt management and availability of emergency expert care and blood transfusion. However, the diagnosis is not always obvious with its varied non-specific presentation. Most common presentation of rupture uterus is acute abdomen, which is often mistaken for other causes like acute pancreatitis, appendicitis, cholecystitis, especially in the early pregnancy. Authors report a case of grand multipara at 19 weeks of gestation presented as acute abdomen. She was referred as incomplete abortion in need of blood transfusion, later diagnosed to be rupture of uterus. She had abdominal pain and vaginal bleeding for 14hours duration prior to admission. On further inquiry, history of blunt trauma to abdomen, the day prior was revealed.

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Use of the Tei Index in the Conservative Management of TRAP Sequence Pregnancies Diagnosed during the Periviable Period: A Case Series

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/2521797 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Kristina Martimucci ◽

Theresa Kuhn ◽

Robyn Bilinski ◽

Jesus Alvarez-Perez

Keyword(s):

Interventional Procedure ◽

Rare Complication ◽

Case Series ◽

Second Trimester ◽

Third Trimester ◽

Tei Index ◽

Fetal Demise ◽

Arterial Perfusion ◽

Trap Sequence ◽

High Output

Twin Reverse Arterial Perfusion (TRAP) Sequence is a rare complication of monochorionic pregnancies. Without intervention, the viable pump twin in a case of TRAP Sequence may develop high output cardiac failure leading to an intrauterine fetal demise. We present 3 cases of TRAP Sequence pregnancy diagnosed during the second or third trimesters of pregnancy. There are minimal sonographic tools for the guidance of a fetal therapeutic interventional procedure during the second trimester or timing of delivery during the third trimester to reduce morbidity and mortality of a viable fetus. Tei index may be a useful sonographic tool in the management of TRAP Sequence during the second or third trimester of pregnancy.

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Uterine rupture: a preventable obstetric catastrophe

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20196012 ◽

2019 ◽

Vol 9 (1) ◽

pp. 151

Author(s):

Bina M. Raval ◽

Apoorva G. Patil ◽

Parav D. Shah

Keyword(s):

Maternal Mortality ◽

Uterine Rupture ◽

Treatment Strategies ◽

Obstetric Care ◽

Fetal Outcome ◽

Morbidity And Mortality ◽

Focused Antenatal Care ◽

Intact Uterus ◽

Study Population ◽

Scarred Uterus

Background: Maternal health has long been acknowledged to be the cornerstone in public health. The objective of this study was to determine the incidence, etiology, risk factors, complications, treatment strategies, maternal and fetal outcome associated with uterine rupture and to determine how to decrease the maternal morbidity and mortality pertaining to it, as it is indeed a preventable obstetric catastrophe!Methods: This is a retrospective study which was carried out in our institute. Analysis of 45 cases of uterine rupture including scar dehiscence, registered/emergency, rupture occurring in the antepartum or intrapartum period, irrespective of previous vaginal or cesarean delivery was done between July 2017 to June 2019 out of 16,330 deliveries. None of the cases were excluded. Statistical analysis was done comparing the mortality in general population and study population and it was determined that it contributes to the maternal mortality significantly hence making it essential to promptly diagnose and treat the cases.Results: The incidence of rupture of uterus is average 0.27% (1 in 362). Out of 45 cases 9 (20%) were registered, and 36 (80%) were referred patients. The 20-30 years age group is the most vulnerable. Scarred uterus undergoing rupture were 34 (75.55%) as compared to rupture in intact uterus which were 11 (24.44%). The commonest modality of treatment used is suturing of tear which was done in 34 (75.55%) followed by total hysterectomy. There were 2 maternal deaths giving maternal mortality rate of 4.44% and perinatal mortality occurred in 18 (40%) cases.Conclusions: Uterine rupture is a dire emergency with a high incidence of maternal and fetal morbidity and mortality. Skilled attendance with accessible obstetric care, focused antenatal care, strict intrapartum monitoring and good surgical approach are key elements for the prevention and management of uterine rupture.

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