Successful Pregnancy after Previous Uterine Rupture

Uterine rupture is a rare and catastrophic incidence with high maternal and fetal morbidity rates. It is most commonly seen in the scarred uterus. The unscarred uterus is least susceptible to rupture with the incidencebeing 1 in 8000 deliveries. In the past, pregnancy after uterine rupture was not widely advised and patients underwent hysterectomy or tubal ligation but with the evolving practice, women are motivated for pregnancy which can be successful with proper obstetric care and emphasis on time and mode of delivery. Here we present a case of 31 years old female, gravida-2 para-1 living 0 with previous uterine rupture after medical induction of labor with stillbirth 4 years ago. She underwent emergency laparotomy with the repair. The patient spontaneously conceived and had close antenatal care throughout the pregnancy. The patient was admitted at 34 weeks of gestation and kept under close surveillance. Corticosteroid was administered. She underwent spontaneous labor at 37 weeks of gestation and emergency cesarean section was planned, delivered via a breech presentation to a live baby of 2.4 kg, APGAR score of 8/10, 9/10 at 1 and 5 minutes.

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Successful pregnancy after previous uterine rupture

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210344 ◽

2021 ◽

Vol 10 (2) ◽

pp. 784

Author(s):

Shamrao Ramjj Wakode ◽

Varsha Narayana Bhat

Keyword(s):

Uterine Rupture ◽

Maternal Morbidity ◽

Breech Presentation ◽

Morbidity Rate ◽

Emergency Laparotomy ◽

Catastrophic Event ◽

Successful Pregnancy ◽

Male Baby ◽

Spontaneous Uterine Rupture ◽

Scarred Uterus

Uterine rupture is a rare and catastrophic event with high fetal and maternal morbidity rate. It is most commonly seen in scarred uterus. Here we present a case of 30 years old female, gravida 3 para 2 living 0 with previous spontaneous uterine rupture at 28-30 weeks with still birth 3 years ago. She underwent emergency laparotomy with repair. She conceived spontaneously, admitted at 20 weeks of gestational age and close antenatal surveillance was done throughout the pregnancy. Corticosteroids was administered. At 36 weeks elective caesarean was planned, delivering via breech presentation to a live male baby of 2.5 kg, Apgar score of 8/10,9/10 at 1 and 5 minutes.

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Pregnancy Outcomes and Associated Factors for Uterine Rupture: An 8 Years Population-based Retrospective Study

10.21203/rs.3.rs-558866/v1 ◽

2021 ◽

Author(s):

Sheng Wan ◽

Mengnan Yang ◽

Jindan Pei ◽

Xiaobo Zhao ◽

Chenchen Zhou ◽

...

Keyword(s):

Retrospective Study ◽

Uterine Rupture ◽

Obstetric Care ◽

Developed Countries ◽

Population Based ◽

Fetal Heart Rate Monitoring ◽

Fetal Complications ◽

History Of ◽

Scarred Uterus ◽

Obstetrical Emergency

Abstract Background: Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications. Methods: This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were retrospectively reviewed.Results: A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10 000 births. 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all case, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcome. 24 (59%) of the ruptures occurred in anterior lower uterine segment. Fetal heart rate monitoring changes were the most reliable signs for rupture.Conclusions: Incidence of uterine rupture in the study area was consistent with developed countries. Further improvement in obstetric care and strong collaboration with referring health facilities was needed to ensure maternal and perinatal safety.

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REVIVAL OF VAGINAL BREECH DELIVERY

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2015.5.1.597-602 ◽

1969 ◽

Vol 5 (1) ◽

pp. 597-602

Author(s):

NASIM AKHTAR

Keyword(s):

Cesarean Section ◽

Neonatal Mortality ◽

Post Partum ◽

Mode Of Delivery ◽

Breech Presentation ◽

Neonatal Morbidity ◽

Maternal Complications ◽

Breech Delivery ◽

Vaginal Breech Delivery ◽

Emergency Cesarean

BACKGROUND: Since the publication of term breech trail there had been a dramatic changeworldwide from selective to planned Cesarean Section for all women with breech presentation at term.This high cesarean section rate led to adverse consequences in subsequent pregnancy &on futurefertility. Choice of safest mode of delivery has always been a dilemma.OBJECTIVE: Prospective interventional study. This study was done to determine the safety of vaginalbreech birth in terms of neonatal & maternal complications, so that to encourage the trend of breechdelivery in carefully selected cases & to discourage the trend of routinely recommending cesareansection for all gravidas with fetus in breech presentation at term. The study was conducted atDepartment of Obstetrics & Gynae Mardan Medical Complex from January 2010 to December 2015.PATIENTS & METHOD: About 809 patients with singleton pregnancy with breech presentation wereincluded. Decision about mode of delivery was taken on the basis of clinical judgment and ultrasoundwhich was further reviewed in the light of rate of progress during labour .Delivery was conducted byexperienced obstetrician. Mother & infants were followed up to 6 wks post partum. The primaryoutcome was neonatal mortality, infant mortality & serious infant morbidity.RESULTS: out of 809 total patients with breech presentation, 714 were planned for vaginal delivery674 delivered (83%) while 40 pts (5%) had emergency Cesarean Sections.95 patients (12%) hadElective cesarean section. In the delivery group two (0.29%) neonates had serious neonatal morbidity. Inthe cesarean group there was no serious neonatal morbidity. Infection & blood loss was greater in thecesarean group. There were no serious maternal complications in the vaginal delivery group. Thedifference between neonatal morbidity, perinatal mortality &neonatal mortality between the two groupswas not significant.CONCLUSION: Vaginal breech delivery is still a safe option which better suits the clinical situation&problems of our patients .In our set up, Cesarean section should not be routinely advised to patientswith breech presentation no matter it may be the best management option in developed countries.Careful case selection & vigilant monitoring of progress of labour will save many patients fromunnecessary section without costing extra morbidity & mortality.KEY WORDS: Breech presentation, Breech Delivery, Cesarean section, Apgar score.

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A Survey on Causes of Cesarean Sections Performed on Women and Their Knowledge towards the Mode of Delivery

Journal of Pharmaceutical Research ◽

10.33140/jpr.05.01.01 ◽

2020 ◽

Vol 5 (1) ◽

Keyword(s):

Cesarean Delivery ◽

Mode Of Delivery ◽

Previous History ◽

Breech Presentation ◽

Cesarean Sections ◽

College Hospital ◽

Cross Sectional ◽

Emergency Cesarean ◽

Special Cases ◽

History Of

Recently elective cesarean delivery rates have increased alongside with emergency cesarean delivery where less information has been conveyed to the women who have been subjected to C-sections. The main objective of C-section is reducing the incidence of maternal and neonatal mortality during childbirth in dangerous situations. It is recommended when there is a risk to mother or child during vaginal delivery. A descriptive type of cross-sectional study design was used. All the data were collected through structured format in questionnaires. The present study was carried out in the department of Obstetrics and Gynecology in the Chittagong Medical College Hospital. The data was collected from 29th September 2019 to 10th October 2019. Most of the patients who were subjected to c section were within the age range of 15-25 (57%). 41% of the cesarean sections were planned whereas 59% were on the basis of emergency and mostly the decision was doctor’s (66%). 58% of the population had enough information before undergoing C-sections and 42% wasn’t fully aware. Among pain medication intake, only 2% of the patients had taken a combination of three pain medications which include paracetamol, metronidazole and suppository. 80% of the patients consumed a combination of paracetamol and suppository whereas only 10% of population consumed paracetamol and metronidazole. 8% of the patients were managed only with paracetamol. 23% of the cesarean patients had a previous history of ceaser and among them some rare special cases had a previous history of 4 ceasers (2%). 43% of the patients suffered pregnancy induced hypertension and 8% suffered pregnancy induced diabetes. 20% of the c section were due to breech presentation and 80% were due to other reasons which included seventeen factors. Patients are not given enough information about C-section and mostly the decisions are taken by the doctors without the consent of the patients.

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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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Dissection of the uterine wall in a scarred uterus: a case report

Gynecological Surgery ◽

10.1186/s10397-021-01083-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Sanne J. M. Zilver ◽

Wouter Wegdam ◽

Angelo B. Hooker

Keyword(s):

Cesarean Section ◽

Uterine Rupture ◽

Fetal Distress ◽

Uterine Wall ◽

Emergency Laparotomy ◽

Vacuum Extraction ◽

Trial Of Labor ◽

Increased Risk ◽

Clinical Consequences ◽

Scarred Uterus

AbstractUterine rupture is a potentially fatal complication during pregnancy, delivery, or postpartum. Women attempting a trial of labor after a cesarean section have an increased risk of a subsequent rupture. We report a case of a 24-year-old woman, gravida 2 para 1 with a previous cesarean section who underwent a trial of labor. During labor she complained of pain while labor progressed rapidly. Because of signs of fetal distress, a vacuum extraction was performed. Two hours after delivery, the patient complained again of severe abdominal pain. Blood accumulated in a previously non-existent area between the serosa and uterine muscle. A dissection of the uterine wall occurred with serious clinical consequences, compatible with a complete uterine rupture. Emergency laparotomy was performed to repair the uterine wall; a hysterectomy was prevented.

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814: Nulliparous women in the second stage of labor: changes in neonatal outcomes over the past 10 years stratified by mode of delivery

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2014.10.1020 ◽

2015 ◽

Vol 212 (1) ◽

pp. S392

Author(s):

Joseph Fitzwater ◽

Nana-Ama Ankumah ◽

Sukhkamal Campbell ◽

Joseph Biggio ◽

John Owen ◽

...

Keyword(s):

Mode Of Delivery ◽

Neonatal Outcomes ◽

Second Stage Of Labor ◽

Second Stage ◽

The Past ◽

Nulliparous Women

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Fetal Malpresentation in Pregnancy

10.2310/obg.19071 ◽

2020 ◽

Author(s):

Afshin Azimirad ◽

Errol R. Norwitz

Keyword(s):

Vaginal Delivery ◽

Medical Center ◽

Breech Presentation ◽

Obstetric Care ◽

External Cephalic Version ◽

Breech Delivery ◽

Advantages And Disadvantages ◽

Ultrasound Evaluation ◽

Elective Repeat Cesarean ◽

Anatomical Part

Fetal presentation refers to that anatomical part of the fetus that presents at the maternal pelvic inlet. The most common and most desirable fetal presentation is cephalic (head first). Any presentation other than cephalic is referred to as a malpresentation. Breech is the most common fetal malpresentation. The prevalence of breech presentation varies with gestational age (25% at 28 weeks and 3-5% of at term). Ultrasound evaluation is the gold standard for the diagnosis of fetal presentation. External cephalic version (ECV) refers to a series of manual manipulations designed to convert a malpresenting fetus to cephalic to promote vaginal delivery. There are two strategies around the timing of ECV; at 36-37 weeks and/or at or shortly after 39 weeks’ gestation. Each has advantages and disadvantages. Currently, most breech pregnancies at term are delivered by cesarean at 39 weeks prior to the onset of labor. Malpresentation is the second most common indication for planned cesarean (behind elective repeat cesarean). Vaginal delivery for a breech fetus at term should only be attempted if the mother is strongly motivated, if the obstetric care provider is experienced, and if the medical center has the requisite facilities to manage any and all complications. This review contains 3 figures, 2 tables, and 66 references. Keywords: fetal presentation, malpresentation, breech presentation, ultrasound evaluation, external cephalic version (ECV), cesarean delivery, vaginal breech delivery

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MODE OF DELIVERY AND ITS IMPACT ON NEONATAL OUTCOMES IN PRETERM INFANTS

Paediatrics & Child Health ◽

10.1093/pch/pxy054.069 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e27-e27

Author(s):

Sarah McKnight ◽

Bishal Gautam ◽

Michael Miller ◽

Bryan S Richardson ◽

Orlando da Silva

Keyword(s):

Caesarean Section ◽

Preterm Infants ◽

Periventricular Leukomalacia ◽

Ductus Arteriosus ◽

Tertiary Care ◽

Mode Of Delivery ◽

Breech Presentation ◽

Neonatal Outcomes ◽

Care Hospital ◽

Significant Difference

Abstract BACKGROUND The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes. OBJECTIVES To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes. DESIGN/METHODS This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher. RESULTS A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity. CONCLUSION Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.

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