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Uterine rupture: Regional incidence, causes and treatment  [PDF]
Mehmet S?dd?k Evsen,M. Erdal Sak,Ya?ar Bozkurt,Murat Kapan
Dicle Medical Journal , 2008,
Abstract: Unscarred uterine rupture is most commonly seen in women having very high parity. In present study, unscarred uterine ruptures in Diyarbak r Maternity Hospital, throughout the last 3 years, were reviewed. In that time period, 26 (0.047%) unscarred uterine rupture were detected among a total of 55013 deliveries. Rupture was occurred at lower side wall of uterus in 25 (95.6%) patients. Causes of uterine rupture were cephalopelvic disproportion (53.8%), excessive use of uterotonics (26.9%) and malpresentation (19.2%).Treatment modalities were total/subtotal hysterectomy in 18 (69.2%) patients, uterine repair in 8 (30.8%), unilateral salphingooferectomy in 7 (26.9%) and hypogastric artery ligation in 5 (19.2%) of patients. Maternal mortality occurred in one patient however perinatal fetal mortality was 13 (50.0%). High hysterectomy ratios of our patients resulted from older age and high parity. In conclusion, maternal and fetal mortality can be decreased in unscarred uterine ruptures, by regular antenatal follow-up and appropriate emergent treatment.
First Trimester Spontaneous Uterine Rupture in a Young Woman with Uterine Anomaly  [PDF]
Esra Nur Tola
Case Reports in Obstetrics and Gynecology , 2014, DOI: 10.1155/2014/967386
Abstract: Spontaneous uterine rupture is a life-threatening obstetrical emergency carrying a high risk for the mother and the fetus. Spontaneous uterine rupture in early pregnancy is very rare complication and it occurs usually in scarred uterus. Uterine anomalies are one of the reasons for spontaneous unscarred uterine rupture in early pregnancy. Obstetricians must consider this diagnosis when a pregnant patient presented with acute abdomen in early pregnancy. We present a case of spontaneous uterine rupture at 12 weeks of gestation in 24-year-old multigravida who had uterine anomaly presenting as an acute abdomen. Our preoperative diagnosis was ectopic pregnancy. Emergency laparotomy confirmed a spontaneous uterine rupture. Uterine anomaly is a risk factor for spontaneous uterine rupture in the early pregnancy. Clinical signs of uterine rupture in early pregnancy are nonspecific and must be distinguished from acute abdominal emergencies. 1. Introduction Rupture of a pregnant uterus is one of the life-threatening complications associated with obstetric practice [1]. There are several risk factors associated with uterine rupture (UR), but the most common is a previous Cesarean section. Unscarred uterine rupture (UUR) is a rare event that usually occurs in late pregnancy or during labour. Risk factors for UUR include high parity, placental abnormalities, and uterine anomaly. UUR during pregnancy, especially before the end of the second trimester, occurs relatively rarely and is associated with high mortality and morbidity for both the fetus and mother. We here report a case of a spontaneous unscarred uterine rupture (SUUR) in early pregnancy, in a woman with a bicornuate uterus. 2. Case Report A 24-year-old woman was admitted to our department with 3-month amenorrhea and sudden, severe, generalized abdominal pain and vaginal bleeding of 2-hour duration. Her first pregnancy resulted in abortus at 8 gestational weeks, but no surgical procedure was performed. On physical examination, the patient was pale with a pulse rate of 130 beats per minute (bpm) and a blood pressure of 80/40?mmHg. The abdomen was tender. Ultrasound examination revealed a 12-week consistent, fetal heartbeat negative pregnancy in the left tuboovarian area and free fluid in the Douglas pouch. Haemoglobin concentration was 7?g/dL. Due to unstable vital signs, two units of screened blood were cross-matched, and the patient was rushed to the operating room. Our preoperative diagnosis was ectopic pregnancy. Laparotomy revealed haemoperitoneum of 1 liter. Further inspection showed a bicornuate uterus
Uterine rupture: UCH, Ibadan experience
T Ogunnowo, O Olayemi, CO Aimakhu
West African Journal of Medicine , 2003,
Abstract: Objective: To determine the incidence, predisposing factors, maternal and fetal outcome of uterine rupture patients at the University College Hospital (U. C. H.), Ibadan. Materials and Methods: A 5-year retropective study of patients with uterine rupture in U. C. H., Ibadan between January 1996 - December, 2000 was done. Results: Thirty five cases of uterine rupture out of a total delivery of 4531 were recorded over the 5-year period. An incidence of 7.75/1000 deliveries or 0.72% was obtained and the yearly trend showss it's on the increase. 85.7% of the patients were unbooked. Common modes of presentation were bleeding per vaginam and abdominal pain. Spontaneous cause of rupture predominates. The interval between diagnosis and surgery was greater than 7 hours in 75% of cases. Uterine repair with or without tubal ligation was commonly employed. Case fatality rate was high at 17.9%. Perinatal mortality was 92.5%. Other maternal morbidities include anaemia, puerperal and wound sepsis, vesico-vaginal fistula and prolonged hospital stay. Conclusion: All the indice at the present time are higher than they were 10 years ago. The incidence is still high and is on the increase. Attributable reasons include type I, II, III delays in health care service utilization associated with poor socioeconomic status of patients and lack of essential drugs and compatible blood in the hospitals.
Thin anterior uterine wall with incomplete uterine rupture in a primigravida detected by palpation and ultrasound: a case report
Shigeki Matsubara, Kazuhiko Shimada, Tomoyuki Kuwata, Rie Usui, Mitsuaki Suzuki
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-14
Abstract: A 27-year-old Japanese primigravid woman was admitted to our hospital due to weak, irregular uterine contractions in her 38th week of gestation. She had no past history of uterine surgery or known diseases. A hard mass was palpable in her abdomen. An ultrasound revealed that the anterior uterine wall was thin and bulging, with a fetal minor part beneath it which corresponded to the palpated mass. A Cesarean section was performed which revealed a thin anterior uterine wall with incomplete uterine rupture. The woman and baby were healthy.Although extremely rare, an unscarred primigravid uterus can undergo incomplete rupture even without discernable risk factors or labor pains. Abdominal palpation and ultrasound may be useful in detecting this condition.Uterine rupture is an obstetric complication associated with significant maternal and fetal morbidity and mortality. This disorder usually occurs in a scarred uterus, especially secondary to prior Cesarean section, and is therefore considered a disease of multigravida [1,2]. A few reports have indicated that a uterine rupture can occur in primigravida, although this is extremely rare [2,3], with etiological or risk factors including a history of uterine surgery, labor augmentation or underlying connective tissue disease [2-4]. A thin uterine wall, as a result of uterine sacculation [5,6] or uterine diverticulum [7], may also induce uterine rupture.We report the case of a primigravid woman with a thin anterior uterine wall; a feature compatible with incomplete uterine rupture. Underlying etiological factors were indiscernible. Her condition was detected by abdominal palpation and then ultrasound. This case report suggests that an unscarred primigravid uterus can show the features of incomplete rupture even in the absence of discernable risk factors and that abdominal palpation and ultrasound may be useful in diagnosis.A 27-year-old Japanese primigravid woman was admitted to our hospital because of slight uterine contract
Spontaneous Uterine Rupture of an Unscarred Uterus before Labour  [PDF]
Mamour Guèye,Magatte Mbaye,Mame Diarra Ndiaye-Guèye,Serigne Modou Kane-Guèye,Abdoul Aziz Diouf,Mouhamadou Mansour Niang,Hannegret Diaw,Jean Charles Moreau
Case Reports in Obstetrics and Gynecology , 2012, DOI: 10.1155/2012/598356
Abstract: Uterine rupture is a public health problem in developing countries. When it is spontaneous, it occurs most often during labor in a context of scarred uterus. Uterine rupture during pregnancy is a rare situation. The diagnosis is not always obvious and morbidity and maternal and fetal mortality is still high. We report a case of spontaneous uterine rupture during pregnancy at 35 weeks of an unscarred uterus before labour. This is an exceptional case that we observe for the first time in our unit. 1. Introduction Rupture of a pregnant uterus is one of the life-threatening complications encountered in obstetric practice. It is a rare complication in developed countries, but is one of the causes of maternal and perinatal morbidity and mortality in Africa. There are several risk factors associated with rupture of uterus, but the most common is a previous Cesarean section. Rupture of an unscarred uterus is a rare event. We report a case of a complete rupture of the uterus before labor, in a gravid woman who had an unscarred uterus. 2. Case A 37-year-old patient, gravida 5 para 4, at 35 weeks of gestation was admitted to the hospital because of an abdominal pain since 18 hours, and vaginal bleeding. Her general medical history revealed no diseases or allergy. Her obstetrical history obtained by anamnesis and her documents revealed a multipara patient with a history of four pregnancies that ended spontaneously by vaginal delivery. Cesarean section has never been performed. Current pregnancy included 2 prenatal visits without sonographic examination. The patient was hemodynamically stable without abdominal tenderness or peritoneal signs. No fetal heart rate was detected. Vaginal examination revealed a closed cervix and no effacement or dilatation. Sonographic examination found an enlarged empty uterus, a fetus in the abdominal cavity, corresponding to 35 weeks of pregnancy (Figures 1(a) and 1(b)). The patient was rushed to the operating room for emergent laparotomy. At the opening of the abdominal wall, the whole intact amniotic sac with fetus inside was protruded into the abdomen (Figure 1(c)). After amniorexis, a male fetus of 2950?g was delivered. Further inspection showed posterolateral uterine rupture interesting the body and extending to the lower transverse segment (Figure 1(d)); the ipsilateral uterine pedicle was intact. Repair of the laceration was not possible. A hysterectomy was performed. No other complications were noticed during the operation and estimation of blood loss was about 1150?mL. The patient received blood transfusion and was discharged
An analysis of uterine rupture at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast Nigeria
SU Mbamara, NJA Obiechina, GU Eleje
Nigerian Journal of Clinical Practice , 2012,
Abstract: Objective: Uterine rupture is a preventable condition which has persistently remained in our environment. The aim of this study therefore is to ascertain the incidence of uterine rupture, examine the predisposing factors and maternal and fetal outcome of patients managed of uterine rupture in a tertiary hospital. Materials and Methods: This descriptive case series was conducted at the department of Obstetrics and Gynaecology, Nnamdi Azikiwe, University Teaching Hospital Nnewi from March 2004 to February 2009. Results: The incidence of uterine rupture was 6.2 per 1000 deliveries. The commonest age range of occurrence was 30-34 years. Uterine rupture occurred predominantly among women of low parity. Previous caesarean section with concurrent use of oxytocics was the commonest risk factor documented.The maternal and perinatal mortality ratio was 94 per 100,000 deliveries and 6 per 1000 births respectively. Surgery was the main stay of treatment and the commonest procedure carried out was uterine repair only. Conclusion: Rupture of the gravid uterus is still a significant cause of maternal mortality and morbidity in our environment. The causes are commonly preventable. The provision of maternal care by skilled personnel, proper antenatal care, update training programmes for health care providers and appropriate legislation on maternal care will significantly reduce the incidence of uterine rupture and improve its prognosis.
Spontaneous Rupture of Uterine Vein in Twin Pregnancy  [PDF]
Emek Doger,Yigit Cakiroglu,Sule Yildirim Kopuk,Bertan Akar,Eray Caliskan,Gulseren Yucesoy
Case Reports in Obstetrics and Gynecology , 2013, DOI: 10.1155/2013/596707
Abstract: Objective. Aim of our study is to present a case of a twin pregnancy following invitro fertilization cycle complicated with hemoperitoneum at third trimester. Case. A 26-year-old nulliparous pregnant woman at 32 weeks of gestation with twin pregnancy following invitro fertilization cycle complained of abdominal pain. After 48 hours of admission, laparotomy was performed with indications of aggravated abdominal pain and decreased hemoglobin levels. Utero-ovarian vein branch rupture was detected on the right posterior side of uterus and bleeding was stopped by suturing the vein. Etiopathogenesis of the present case still remains unclear. Conclusion. Spontaneous rupture of the uterine vessels during pregnancy is a rare complication and may lead to maternal and fetal morbidity and mortality. Diagnosis and treatment are based on the clinical symptoms of acute abdominal pain and laboratory tests of hypovolemic shock signs. 1. Introduction Hemoperitoneum in pregnancy is a rare but a dramaticlife threatening complication that results from ruptured uterine vessels [1]. Even though the etiology is poorly understood, sudden rise in venous pressure turning out to vessel rupture and decidualised endometriosis invading vessel wall may be counted as responsible risk factors. In the English literature, approximately 150 cases of rupture of uterine vessels have been reported until now. Brosens et al. stated in their article that bleeding vessels were venous, arterial, or unknown (80%, 16% and 4%, resp.) [2]. Here we present a case of a twin pregnancy complicated with hemoperitoneum following in vitro fertilization cycle (IVF) as a result of utero-ovarian vein branch rupture. 2. Case A 26-year-old nulliparous woman with a dichorionic-diamniotic twin pregnancy achieved by assisted reproductive techniques was admitted at 32 weeks of gestation. At admission, her complaints were epigastric pain and flank pain. Until that time, the patient had an uneventful pregnancy without history of vaginal bleeding, abdominal trauma, uterine contraction, or recent sexual intercourse. Her past medical history included neither abdominal surgery nor myoma uteri. On physical examination, the temperature was 36°C, the blood pressure was 110/70?mm Hg, the pulse was 92 beats per minute, and respiratory rate was 24 beats per minute and vital parameters were normal. At initial abdominal examination, she had no rebound tenderness. Pelvic examination was one cm dilated with a soft cervix. Cardiotocography showed irregular contractions with reactive fetal heart rate tracing. Hemoglobin (Hb) was
A two-year review of uterine rupture in a regional hospital
CO Fofie, P Baffoe
Ghana Medical Journal , 2010,
Abstract: Background: Uterine rupture causes high maternal and neonatal mortality in many rural setting in the world. Further studies might provide specific interventions to reduce the high prevalence. Objective: To determine the frequency, causes, clinical presentation, management and outcome of uterine rupture Setting: Department of Obstetrics and Gynaecology, Upper West Regional Hospital, Wa, Ghana. Design: Retrospective descriptive study. Method: A descriptive study of cases of ruptured uterus in the Regional Hospital from 1st January, 2007 to 31st December 2008 was done. A structured questionnaire was developed to collate data from various registers for analysis. Results: Total deliveries were 5085 with 4172(82%) spontaneous vaginal delivery and 911(17.9%) caesarean sections. Uterine rupture occurred in 41 cases for a ratio of 1:124 Grand multipara with five or more deliveries represented 41.5% while those with two prior successful deliveries represented 31.7%. The mean parity was 3.8 (SD 2.3) under antenatal care, 85.4% had at least four visits. Severe anaemia 28(68.3%) and abdominal tenderness 27(65.8%) were the most frequent clinical presentation while the use of local herbal concoction with suspected uterotonic activity 24(58.5%), fetopelvic disproportion 4 (9.8%) and malpresentation 5(12.1%) were the most significant causes. Major complications were: neonatal deaths 34(82.9%), maternal mortality 4(9.8%) and wound infections 15 (36.6%). Subtotal hysterectomy 10(24.4%) and total hysterectomy 18(43.8%) were preferred to uterine repair 12(23.3%) and 87.8% required at least two units of blood transfusion. Conclusion: skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.
Protective compromise of great omentum in an asymptomatic uterine rupture in a bitch: a case report
González-Domínguez,María S; Hernández,Carlos A; Maldonado-Estrada,Juan G;
Revista Colombiana de Ciencias Pecuarias , 2010,
Abstract: the great omentum plays an important role in protecting the peritoneal cavity from bacteria and contaminating material and providing the peritoneum with leukocytes from the omental milky spots (oms). however, there are no reports on the existence of oms in dogs. in this report an unusual case of asymptomatic uterine rupture (ur) is described in a 16 month old pointer bitch that was admitted at the ces university veterinary clinic in medellin (colombia) for elective neutering. in the abdominal surgical plane, the great omentum was found sequestering abundant macerated fetal debris and uterine content released near the ruptured uterine wall. a severe congestive and brown-like appearance of peritoneum suggesting a protective inflammatory process was observed. all uterine contents, uterus and compromised great omentum were completely removed. the dog recovered satisfactorily with no clinical complications after a long term postsurgical period. additionally we discuss the existence of oms in the canine omentum.
Misdiagnosed Uterine Rupture of an Advanced Cornual Pregnancy
Christian Linus Hastrup Sant,Poul Erik Andersen
Case Reports in Radiology , 2012, DOI: 10.1155/2012/289103
Abstract: Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability.
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