Idiopathic uterine perforation in late pregnancy

Abstract

Case reportA 27-year-old primigravida with no significant history attended for booking at 13 weeks. Her booking examination and investigations were entirely normal. An ultrasound confirmed a single normal 13-week-sized intrauterine pregnancy and routine detailed scan at 20 weeks reported no abnormalities.The patient presented at 38 weeks +3 days with blood pressure of 130/90 mmHg, but without proteinurea. Serum biochemistry was normal. The plan was to induce labour in a week's time while the blood pressure was to be checked on alternate days by the community midwife.A week later she presented with a constant vague abdominal pain, and vomiting of 1 hour's duration without visual symptoms or headache. On examination, she looked in pain and uncomfortable. Her vital signs were normal. She was unable to provide a urine sample on admission. Her abdomen was very tense, but there were no contractions. The symphysis-fundal measurement corresponded with gestational dates, fetus lying longitudinally in the cephalic presentation. The CTG trace was reactive. Blood biochemistry was normal and the same as the previous week. She was managed conservatively with analgesics.Eight hours later, her pain had increased and the pain was worst in the region of the uterine fundus. Fetal ultrasonograph showed normal Doppler flow and no fetal abnormalities but severe oligohydramnios and large amounts of ascitic fluid in the maternal abdomen. A surgical cause for her pain seemed likely and she was prepared for laparotomy to deliver the baby followed by exploration of the abdomen with the assistance of a general surgeon.Laparotomy was performed through a midline subumbilical incision. A large collection of liquor-like fluid, filling the whole abdomen, was removed by suction. A healthy baby was delivered by routine lower segment caesarean section with minimal liquor noted.Exploration of the uterus revealed a uterine perforation at the fundus, medial to the right cornua. The perforation was 3 mm in diameter, lined with what seemed to be granulation tissue. In the same position on the left side, there was a similar area of thinning of the uterine muscle thinly covered with membranous tissue. Both ovaries were adherent to the posterior uterine wall. No other abnormalities were noted. A biopsy was taken from both sites before closing the defects with sutures. The uterus was very atonic and required IV Syntocinon and i.m. prostaglandin to obtain an adequate contraction. Exploration of other abdominal organs revealed no abnormalities.Blood culture and swabs from both uterine perforations and placenta were negative for bacterial growth. The patient made an excellent recovery and was allowed home on the fifth postoperative day. She was advised to have an elective caesarean section at 38 weeks' gestation in her further pregnancies. Biopsy of the rightside perforation showed an area of acute muscle infarction adjacent to a focus of apparent pre-existing scarring, with collagenisation and serosal adhesions. On the left side the biopsy consists of partly ...

Rotura Uterina Espontánea en El Primer Trimestre Del Embarazo

“…El factor independiente más importante es la cicatriz uterina previa (perforación, resección cornual, resección de septo uterino, miomectomía, cirugía fetal, operación cesárea) (11). Se asocia también a pacientes con gran paridad (12), placenta increta o percreta, instrumentalización uterina en abortos, parto vaginal instrumental, inducción del trabajo de parto (13), abuso de cocaína (14) y causas idiopá-ticas (15). Estos factores se asocian a rotura uterina en tercer trimestre del embarazo o peri-parto y, aunque algunos investigadores informan sobre la ruptura uterina en mujeres no embarazadas (16,17) estas no son más que anecdóticas.…”

Spontaneous Uterine Rupture in the First Trimester: A Case Report

“…The past injuries such as Cesarean delivery, hysteroscopic resection of uterine septum, myomectomy, and cornual resection are considered to be the causes of uterine rupture (5). It is reported that spontaneous rupture of unscarred uterus occurs in 1 in 15,000 (6). It may occur in a patient who has high parity (7), placenta increta or percreta, adenomyosis, abortion with instrumentation, manipulation during delivery, induced delivery by misoprostol (8), vigorous fundal pressure during delivery, cocaine abuse (9) and idiopathic cause (6).…”

“…It is reported that spontaneous rupture of unscarred uterus occurs in 1 in 15,000 (6). It may occur in a patient who has high parity (7), placenta increta or percreta, adenomyosis, abortion with instrumentation, manipulation during delivery, induced delivery by misoprostol (8), vigorous fundal pressure during delivery, cocaine abuse (9) and idiopathic cause (6). Most of the above listed causes shows that uterine rupture is mainly occur before or during labor after the second trimester.…”

Case report on placenta accreta presenting obstetric emergency

“…In some cases, no cause can be identified, and these are considered idiopathic. [7][8][9] Magnetic resonance imaging and Doppler sonography can be used for the prenatal diagnosis of placenta increta. 10 However, the diagnostic value of sonography in prenatal diagnosis of an asymptomatic placenta increta is uncertain.…”