A Large Amniocele with Protruded Umbilical Cord Diagnosed by 3D Ultrasound

Abstract

An amniocele is a herniation of the amniotic sac through a uterine defect. Uterine rupture during pregnancy may develop as a result of a pre-existing injury, uterine anomaly, or unscarred uterus. A 30-year-old patient, with a history of 2 vaginal deliveries, presented an amniocele complicated by left fundal perforation and was evaluated with 3-dimensional ultrasound at 23 weeks. Because of worsening lower abdominal pain and vaginal bleeding, she underwent exploratory laparotomy. Herein, we report a uterine rupture with amniocele.

Defect in the uterine wall with prolapse of amniotic sac into it at 32 weeks' gestation in a primigravida woman without any previous uterine surgery

“…As the myometrial defect was without hemorrhage, and both the patient and infant were in stable conditions, it is considered reasonable that a prolapse of the amniotic sac occurred incidentally at 32 weeks' gestation through the myometrial defect, which was either pre‐existing or developed naturally with the progression of pregnancy. Although causation of the myometrial defect was also unclear, a similar case of uterine wall defect with amniocele was reported previously …”

Rupture of uterine muscle hematoma following diagnostic amniocentesis at 18 weeks and uterine dehiscence at term

“…3 It is often associated with acute symptoms and/or blood loss. 4 Factors that can predispose to uterine rupture are multiparity, advanced maternal age, a scarred uterus, a big foetus, mal presentation, and others. 5 Uterine dehiscence / incomplete uterine rupture / silent rupture is classically defined as a disruption of the uterine musculature, without extravasation of the intraamniotic contents and foetal parts into the peritoneal cavity, and with intact serosa.…”

“…5 Uterine dehiscence / incomplete uterine rupture / silent rupture is classically defined as a disruption of the uterine musculature, without extravasation of the intraamniotic contents and foetal parts into the peritoneal cavity, and with intact serosa. 4 In most cases it is asymptomatic. pregnancy" to find clinical cases, trials and reviews that are, in our opinion, most relevant to our case.…”

“…Investigating literature, we found only one published case report in which amniocentesis is proposed to be the leading cause of uterine rupture. 15 Williams and Stallworthy reported a case of a deadly uterine hematoma at the puncture site. 16 Cases of significant maternal blood loss secondary to lacerated uterine artery or vein have been reported.…”

HDlive for Assessment of Placenta and Umbilical Cord

“…[1][2][3][4][5][6][7][8][9] Three-dimensional ultrasound has the potential to provide improved visualization of the placental and umbilical cord anatomic morphology compared to twodimensional (2D) sonographic imaging. 10 HDlive, the latest ultrasound technology, facilitates the creation of clearer placental and umbilical cord images than those obtained using conventional 3D ultrasound owing to better depth perception and the depiction of skin-like colors, which gives the placental and umbilical cord images a more realistic appearance.…”