Analysis on the Outcome of Tubal Interstitial Pregnancy after Partial Cornual Resection

Objective: To investigate the safety of re-pregnancy after partial cornual resection for tubal interstitial pregnancy. Methods: The clinical data of 22 cases of re-pregnancy after partial cornual resection from November 20J 3 to June 20J 9 were retrospectively analyzed, the operation condition, re-pregnancy outcome and neonatal outcome were analyzed. Results: 18 of the 21 cases were tubal interstitial pregnancy, the re-pregnancy interval was 6-36 months, the median delivery time was 17.4 moths, the median delivery time was 36 weeks (28-41+2W), there was 2 cases of birth weight <2500 g. The remaining 4 cases were interstitial heterotopic pregnancy, the median delivery time was 36 weeks (32+4-38+2W), there was 1 case of birth weight <2500g. Of the 22 patients, 21 were delivered by cesarean section and 1 was vaginal delivery, all the newborns survived. There were no cases of rupture of uterus, adhesion or implantation of placenta at uterine horn. Conclusion: The patients with tubal interstitial pregnancy after standard partial cornual resection have a good outcome of re-pregnancy.

Uterine Perforation in Postmenopausal Woman – Case Report

Rupture of uterus occurring spontaneously is a rare occurrence. Here we are presenting a case of spontaneous postmenopausal rupture of uterus caused by pyometra. This can be associated with high morbidity if generalized peritonitis and sepsis occurs. The symptoms will be like acute abdomen similar to that caused by ruptured bowel or gastric perforation. In case of postmenopausal rupture like ours, gynaecological symptoms are very less. Hence the diagnosis becomes difficult and challenging. Here we report a rare case of uterine rupture that occurred in a postmenopausal woman because of pyometra. The patient landed up in the surgical department as case of acute abdomen. Definitive diagnosis was made at the time of laparotomy only when exploration was done and gynaecologist called.

Obstetric Haemorrhage Related Maternal Mortality: A Two-Year Experience at a Teaching Hospital in Bangladesh

Background: Bangladesh is one of the developing countries where the maternal mortality is extraordinarily high. Objectives: This study was conducted to find out the number and cause of obstetric haemorrhage related maternal death. Methodology: This retrospective study was conducted in the department of obstetrics & gynaecology at M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh from January 2006 to December 2007. From all maternal deaths related to pregnancy occurred in that period, only death due to obstetric hemorrhage were enrolled. Thereafter, the records of hemorrhage related death patients were scrutinized and data were collected from death register. All necessary information was collected in a pre-designed clinical data sheet and analyzed. Results: Among all deaths in obstetric unit, maternal mortality due to obstetric haemorrhage was 32.09%. The deaths were common among multipara (3-4) in 26-30 years age group. Most of them were from lower socio-economic condition having no or irregular antenatal checkup. Among the causes of obstetric haemorrhage, PPH was the commonest. Atonic uterus was the main cause of PPH. Injudicious use of oxytocin and obstructed labour were the common cause of rupture of uterus. Although the causes of haemorrhage were different, most of the patients died due to haemorrhagic shock. Conclusion: This study helps to detect the magnitude of problem and major causes of maternal deaths specially haemorrhage related maternal deaths. Journal of Current and Advance Medical Research, July 2021;8(2):90-94

A rare Case of Cesarean Section Scar Ectopic Pregnancy Managed by Laparotomy

Cesarean section scar ectopic pregnancy (CSEP) is defined as a pregnancy in which blastocyst is implanted within the scar of previous cesarean section. It is a rare form of ectopic but its frequency is increasing due to increasing rate of cesarean section. In this case, a 36 years old G3P2A0, married for 10 years, previous II C/Sections, LCB 7 years back, presented with ultrasound report of the viable pregnancy at 11+1 weeks with gestational sac incorporating into previous scar of cesarean section. She was otherwise asymptomatic and stable. Serum Beta hCG was 73664.78 IU/L. Laparotomy was done as an elective procedure. Dense adhesions were noted on opening the abdomen between anterior abdominal wall, uterus, bladder and gut. Scar ectopic pregnancy was excised after dissecting the adhesions. Her Serum Beta hCG 48 hour post-operatively was 1397.0 IU/L.Patient was discharged home on 2nd post-operative day in good condition. She was counselled about risk of a recurrent scar ectopic and rupture of uterus in next pregnancy. Her serum Beta hCG declined to normal by 4 weeks post operatively. Keywords: Cesarean section, scar ectopic, laparotomy

A CASE REPORT -UTERINE RUPTURE AFTER PREVIOUS CAESAREAN SECTION

Uterine rupture though a rare complication is life threatening for mother as well as baby. The commonest cause for rupture of a gravid uterus is previous caesarean section. It is important that the risk of rupture of uterus is explained to the pregnant female who has undergone previous caesarean section. The symptoms with which the patient presents can be subjective and vague like pain in abdomen or of acute abdomen. The patient can also come with objective findings like non-reassuring fetal status and loss of fetal station. With previous caesarean section it is important to be vigilant throughout the pregnancy especially in third trimester. It is also imperative that the patient should be educated about the signs and symptoms of rupture uterus so that timely intervention can be done to save the life of mother and the baby. In the present case study, the USG scan revealed that the placenta had shifted and was covering the internal os from fundo-posterior position along with the shift of baby from cephalic presentation to transverse lie. Hence these case was a suspicious of rupture uterus which causes change in lie as well as presentation of baby.

Rupture of right non-communicating horn of bicornuate uterus with twin pregnancy

The rupture of uterus in first and second trimester is very rare and mostly associated with uterine anomalies or cornual pregnancy. Bicornuate uterus (BU) is a uterine anomaly results from incomplete fusion of the two Mullerian ducts during embryogenesis. Here we are presenting a case of primigravida in the second trimester (20 weeks) as ruptured ectopic pregnancy in emergency. Laparotomy showed BU with twin pregnancy in the ruptured non communicating right horn. Right horn excision was done. This case highlights the twin pregnancy in non-communicating horn of uterus and its rupture in early pregnancy. Cases with non-communicating horn are reported but twin pregnancy in noncommunicating horn is a rare one. In asymptomatic women, the presence of bicornuate uterus may not be detected until during pregnancy or delivery. In case of pregnancy in rudimentary horn, early sonographic diagnosis has a major contribution in evaluation and management. Treatment usually involved is resection of the ruptured horn. Since the scar is present on the uterus, it is important to avoid pregnancy for at least 1 year.

Rupture of uterus during labour. Hysterectomy

M.S., 42 years old, multipara, slipped 28 / xii 93, a few days before the onset of urgent labor, and badly hurt her lower abdomen in a sharp stone.

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

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.

A case report: spontaneous postpartum rupture of unscarred uterus

Rupture of uterus is characterized by a breach in the wall of the uterus involving its full thickness. An unscarred uterus rupture is uncommon. It has non-specific symptoms and presentation differs according to site and time of rupture. Authors report an unusual case of spontaneous rupture of unscarred uterus. A 32-year-old, pregnant woman, developed postpartum bleeding with no history of prior uterine incision. She was diagnosed as a case of rupture of uterus and emergency laparotomy was done. Early diagnosis and immediate surgical intervention may significantly improve the prognosis. Differential diagnosis of uterine rupture should always be kept in mind in all patients with or without risk factors.

Spontaneous rupture of an unscarred uterus during pregnancy: an interesting case report

Uterine rupture in pregnancy is very rare and potentially catastrophic for both mother and foetus. The most common cause of uterine rupture is giving away of previous caesarean uterine scar. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present a rare case of a spontaneous complete uterine rupture in a non-labouring unscarred uterus of a 33-year-old nulliparous woman at 35 weeks of gestation. She presented with lower abdomen pain and decreased foetal movements at Institute of Obstetrics and Gynaecology, Chennai. Even before getting into labour, patient suddenly collapsed, and emergency laparotomy was proceeded in view of suspicious concealed abruption. There was frank hemoperitoneum along with a dead baby in the abdominal cavity. There was rupture of uterine fundus extending from one cornual end to the other and closure of uterine rent proceeded. Spontaneous rupture of uterus occurs when there is an upper segment uterine scar. She had a past history of eventful uterine curettage which was the risk factor for uterine rupture.