Complete Uterine Rupture: A Case Report

Abstract

Submit Manuscript | http://medcraveonline.com 0.012 to 0.3 %, with higher incidence in developing countries [1,2]. Among the several predisposing factors, a history of previous cesarean delivery remains the most important etiological factor [3]. Neonatal mortality is higher in women who present with uterine rupture when compared with the general obstetrical population, at rates of 51/1000 and 1.4/1000 respectively [3].Incidence of maternal mortality rate after trial of labor with prior cesarean delivery (TOLAC) or post repeat elective cesarean delivery (ERCD) is around 7/100000 births and marginally higher in the former group [4,5]. The rate of cesarean deliveries has increased over the past two decades in most countries, varying from 15 % to 40 % of deliveries, with Northern European countries having the lowest rates [6]. Uterine rupture is more frequent with TOLAC than ERCD [7]. Case ReportA 36 year old woman presented with a history of previous cesarian section 4 years ago, was admitted to the maternity ward at 40 weeks of gestation with spontaneous onset of labor. She was considered for a trial of labor. She had no medical problems and was not on any medications. She was a non smoker and teetotaller. Her body mass index was 24.8 kg/m 2 . On admission to the labor ward, epidural catheter was placed. Monitoring during labor consisted of fetal electrocardiogram, tocometer, non invasive blood pressure, ECG and pulse oximetry. An oxytocin infusion containing 5 units in 49 milliters of a glucose solution according to the local protocol was set up (5.436 units of oxytocin were admininstered over the entire labor) and after twelve hours of labor a baby boy weighing 2.994 kilograms (kg) was delivered using outlet forceps. The newborn had an Apgar score of 4/7/9/10 at 0,1,5 and 10 minutes. Three minutes after delivery, the parturient developed profuse vaginal bleeding with severe hypotension, tachycardia, intense abdominal pain, and obtunded consciousness. Suspecting uterine rupture, the patient was wheeled to the operation room for surgical exploration under general anaesthesia. Three 18 gauge intravenous cannulaes were secured and one litre Ringer lactate infused rapidly prior to induction of anaesthesia. Induction was done with 100 mg ketamine and 100 mg celocurine intravenously and rapid sequence tracheal intubation done employing the Sellick's manouvre. Anesthesia was maintained with oxygen, air and 2% sevoflurane. The abdomen was opened by a Pfannenstiel incision and moderate hemoperitoneum encountered. The previous cesarean section scar was completely ruptured. The rent was closed in layers and peritoneal toilet done. A large hematoma along the anterior wall of the uterus was also evacuated. Hysterectomy was not considered and 500 micrograms of sulprostone was infused over a period of one hour followed by another dose of 500 micrograms over five hours. Blood loss was estimated at 1500 mililiters (ml). The patient received 3 units of packed red blood cells, 2 units of fresh frozen plasma, 3 grams of fibrinogen, ...

Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital

“…In such patients with atypical history, the diagnosis of uterine rupture might be delayed significantly or may be established only during laparotomy with macroscopic evidence. Because this can result in maternal and fetal mortality, treating clinicians should be aware of such atypical presentations of uterine rupture [17].…”

Gimdos Plyšimo Ir Atonijos Sukeltas Kraujavimas. Klinikinis Atvejis

“…Tikėtina, dėl to trečiojo gimdymo metu įvyko gimdos plyšimas [17]. 2017 metais aprašytas atvejis, kai 36 metų pacientei 40 nėštumo savaitę plyšo gimda, rando po cezario pjūvio operacijos prieš 4 metus vietoje [18]. Kiek kitoks 30 metų moters, kuriai prieš 2 metus atlikta cezario pjūvio operacija, atvejis: ji pagimdė prieš 23 dienas namuose, natūraliais gimdymo takais pagimdė.…”