Second‐trimester and early third‐trimester spontaneous uterine rupture: A 32‐year single‐center survey

Abstract

Background Second‐trimester and early third‐trimester uterine rupture in a nonlaboring woman is a very rare and life‐threatening condition for both mothers and newborns. We aimed to present clinical characteristics, prenatal findings, and maternal and neonatal outcomes following second‐trimester and early third‐trimester spontaneous antepartum uterine rupture in our institute. Method The medical records of all women with full‐thickness second‐trimester and early third‐trimester uterine rupture treated in our department from 1988 to 2019 were retrieved from the institutional database and reviewed. Small uterine defects, incomplete ruptures, and silent uterine incision dehiscence were excluded. Results From 1988 to 2019, 213 665 deliveries were recorded in our institute. Of these, 12 patients experienced second‐trimester or early third‐trimester spontaneous uterine rupture. Obstetric history revealed that 50% of the women in each period had undergone previous classical uterine incisions and 50% had a short interpregnancy (IP) interval. The mean age at diagnosis of uterine rupture was 26.3 ± 5.1 weeks. The ruptures were associated with abnormal placentation in 10 cases (83.3%): placenta previa (n = 7); and placenta previa and percreta (n = 3). No maternal mortality occurred. Seven of the 10 (70%) viable newborns survived. Conclusions The increasing rates of cesarean births (CB) may lead to iatrogenic complications including midgestational prelabor spontaneous uterine rupture, an obstetric emergency, which is hard to diagnose. Maternal and neonatal outcomes can be optimized by a greater awareness of the risk factors, recognition of clinical signs and symptoms, and the availability of ultrasound to assist in establishing a diagnosis to enable prompt surgical intervention.

Silent uterine rupture in the term pregnancy: Three case reports

“…[ 5 ] The most prevalent causes of uterine rupture are widely recognized to include prior laparotomic myomectomy followed by subsequent cesarean section, [ 5 , 6 ] previous cesarean section, [ 7 ] a short interpregnancy interval or brief interval between myomectomy and conception (i.e. <12 months), [ 8 ] abnormal placentation, placenta previa and percreta, [ 9 ] or surgical termination of pregnancy. [ 4 ] Nevertheless, cases of uterine rupture have also been documented in primigravida patients without evident risk factors.…”

Uterine rupture in the third trimester of a pregnancy subsequent to a cesarean section by transverse uterine fundal incision: A case report and literature review

“…Although the incidence of uterine rupture after cesarean section is as low as 0.3%, 5 it can occur suddenly even in the absence of labor, resulting in maternal and fetal morbidity and mortality. 6 To reduce the risk of uterine rupture and preterm birth in the next pregnancy, in most cases a low transverse uterine incision is generally chosen rather than a vertical incision. 7 Another benefit of this choice is that early detection of muscle layer changes on the scar by ultrasonography in subsequent pregnancies is much more likely.…”

Uterine rupture in the third trimester of a pregnancy subsequent to a cesarean section by transverse uterine fundal incision: A case report and literature review

“…7 In women who have had a cesarean section, uterine rupture can suddenly occur even in the absence of labor, although induced labor has been known to be a leading cause of uterine rupture. 8 The typical signs of uterine rupture include abdominal pain, bleeding, shock and fetal distress. 9 Thus, uterine rupture should be considered in the differential diagnosis of severe abdominal pain, especially for patients with risk factors for uterine rupture.…”