Prenatal Detection and Conservative Management of a Partial Fundal Uterine Dehiscence

Abstract

Uterine defects in pregnancy are rare and may pose difficulties in definition and clinical management. Defects involving the myometrium encompass entities such as uterine rupture, dehiscence, sacculation or diverticulum. There are only a few reported cases of uterine fundal defects where the pregnancy continues into the third trimester. The following case describes the prenatal imaging diagnosis and subsequent clinical management of a large fundal uterine defect in the third trimester of pregnancy.

Antepartum uterine rupture at 29 weeks gestation following unilateral salpingectomy and review of literature

“…To date there is no reliable data of what the benchmark ‘norm’ of myometrial thickness should be or how thin the myometrium can become to prompt early delivery 14 15…”

Expectant management of a herniated amniotic sac presenting as silent uterine rupture: a case report and literature review

“…A total of 16 cases (surgical group) underwent surgical intervention, including termination of the pregnancy and repair of uterine wall at 23.1 ± 7.7 weeks of gestation [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. In contrast, eight cases (expectant group) were managed expectantly (initial manifestation at 22.0 ± 6.9 weeks of gestation), and the latency periods (interval between diagnosis and delivery) were 9.0 ± 7.2 weeks [1][2][3][4][5][6][7]. Although all cases in the expectant group underwent caesarean section prior to full-term due to worsening abdominal pain, abnormal foetal heart rate patterns, or labour onset, the mothers all gave birth to healthy babies.…”

“…To date, its influence on pregnancy has not been fully clarified when a patient is asymptomatic or shows temporary abdominal pain that is not accompanied with foetal distress. If a patient and her partner strongly wish to continue with the pregnancy, they must be provided with an extensive review of the potential risks for expectant management, including subsequent uterine rupture [7], placenta accreta [1,5], hysterectomy [1,5], and preterm birth [1][2][3][4][5][6][7].…”

“…Uterine dehiscence, defined as separation of a prior uterine scar not extending to the serosa, is often used to describe a herniated amniotic sac with focally overstretched uterine wall [4,5,7,10,11,14,16,20,21]. However, extensive review of the literature does not provide obvious evidence that separation of a pre-existing scar does occur during pregnancy in cases presenting with a herniated amniotic sac.…”

“…Moreover, "uterine rupture" is sometimes used to describe a herniated amniotic sac in the reviewed articles [2,3], because the distinction between silent uterine rupture and complete uterine rupture is not always clear by sonography alone. Among the eight women in the expectant management group, there was one case who resulted in complete uterine rupture [7], while the rest of them required caesarean section due to potential uterine rupture [1][2][3][4][5][6] Table 1. Literature review of a herniated amniotic sac out of overstretched uterine wall before 34 weeks' gestation.…”