Two‐ and three‐dimensional sonographic diagnosis of incomplete uterine scar rupture during pregnancy

Taipale, Pekka; Karhumaa, J.; Penttinen, Jorma

doi:10.1002/uog.1869

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…Another similar case was reported by Sentilhes et al 11. Taipale recently described a case of conservative management of uterine‐scar dehiscence measuring 18 mm in diameter, diagnosed by 3D ultrasound12.…”

supporting

confidence: 65%

Expectant management of fetal arm extruding through a large uterine dehiscence following sonographic diagnosis at 27 weeks of gestation

Rabinowitz

Samueloff

Sapirstein

et al. 2006

Ultrasound in Obstet & Gyne

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A 25-year-old woman, gravida 4 para 3, presented at our antenatal clinic complaining of abdominal pain at 27 weeks of gestation. The patient's obstetric history consisted of two normal term deliveries. In her third pregnancy holoprosencephaly was diagnosed and at 26 weeks of gestation feticide was performed followed by hysterotomy due to placenta previa. The uterine incision was low transverse.Ultrasound examination demonstrated a single fetus in breech presentation with an estimated weight of 1030 g and decreased amniotic fluid volume. The cervical length was 35 mm. Midway between the internal os and the uterine fundus, we observed dehiscence of the scar measuring 50 × 26 mm, with a large herniated amniotic sac extending into the maternal abdominal cavity ( Figure 1, Videoclip S1). The extrauterine amniotic sac measured 100 × 45 mm and contained most of the amniotic fluid as well as a fetal arm and shoulder. These findings were also demonstrated on three-dimensional (3D) ultrasound (Figure 2, Videoclip S2). Following broad perinatal consultation we presented to the patient the benefits and potential risks of immediate delivery compared with expectant management. As she was asymptomatic at this point, expectant management was chosen, with the understanding that any change for the worse would necessitate immediate intervention. She was assigned a dedicated midwife and was followed without intervention. Betamethasone for lung maturation and magnesium sulfate for tocolysis were administered and instructions were issued for complete bed rest. Tocolytic treatment was discontinued after 1 day and the following 2.5 weeks were uneventful. Serial ultrasound examinations demonstrated the fetal arm and a loop of cord moving repeatedly in and out of the uterine cavity and the herniated amniotic sac (Figure 3). Seventeen days later, on follow-up ultrasound examination, the herniated amniotic sac had disappeared and severe oligohydramnios was observed. The arm was located outside the uterine cavity. Premature rupture of the membranes was diagnosed and an

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supporting

confidence: 65%

Expectant management of fetal arm extruding through a large uterine dehiscence following sonographic diagnosis at 27 weeks of gestation

Rabinowitz

Samueloff

Sapirstein

et al. 2006

Ultrasound in Obstet & Gyne

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“…The prenatal detection of corporeal uterine rupture without hemoperitoneum and maternal compromise is rare and limited to a few case reports [9,10] . Incomplete uterine rupture with preservation of the integrity of the amniotic sac, frequently denoted by the term uterine dehiscence, has also been reported prenatally, both in the lower uterine segment [1,11] and the uterine corpus [2,8,12] . Previous reports of cases involving incomplete dehiscence in the uterine corpus presented with acute abdominal pain in the third trimester and were managed with emergency cesarean delivery and repair of the defects [2,8] .…”

Section: Discussionmentioning

confidence: 99%

“…Dehiscence is usually diagnosed in women with a prior cesarean delivery, with an incidence of 4-5% being reported [11] . It has been estimated that 50-70% of uterine rupture or dehiscence cases are due to defects in prior cesarean scars [8] .…”

Section: Discussionmentioning

confidence: 99%

Prenatal Detection and Conservative Management of a Partial Fundal Uterine Dehiscence

2009

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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.

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“…Sonographic diagnosis of a uterine rupture has rarely been described in the literature. mainly been performed to confirm the diagnosis either during pregnancy 18 or postpartum. 19 It is a common belief that sonography is a diagnostic tool that can readily show acute uterine rupture, thus permitting surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Findings and Surgical Management of a Uterine Rupture Associated With the Use of Misoprostol During Second-Trimester Abortion

Papantoniou

Mesogitis

Papageorgiou

et al. 2005

Journal of Ultrasound in Medicine

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isoprostol, a synthetic analogue of prostaglandin E 1 , is gaining popularity for use in second-trimester pregnancy termination worldwide, and several studies have reported excellent results with its use in the second trimester of pregnancy.1,2 In women with previous cesarean delivery, the use of prostaglandins for labor induction during the second or third trimester is considered dangerous because of the risk of uterine rupture.3,4 The incidence of this complication after misoprostol administration in women with a scarred uterus in the second trimester is unknown. In a retrospective study examining whether a previous cesarean delivery carries a higher risk of complications in women who undergo pregnancy termination with misoprostol, no increased risk of uterine rupture was found. 5In this report, we describe a case of uterine rupture during a second-trimester pregnancy termination with misoprostol in a woman with a previous cesarean delivery. Apart from the clinical symptoms, the diagnosis was based on the sonographic findings that prompted surgical intervention. Case ReportA healthy 22-year-old woman, gravida 2, was admitted at 23 weeks' gestation, to our hospital for pregnancy termination after prenatal diagnosis of spina bifida. The patient's medical history was unremarkable. The obstetric history included 1 prior cesarean delivery 2 years earlier because of cephalopelvic disproportion, which was uncomplicated. Four hundred micrograms of oral misoprostol and 400 µg of intravaginal misoprostol were given initially. The same dose (400 µg) of intravaginal misoprostol was repeated 8 hours later. Two hours after the second administration, the patient had vaginal bleeding, and digital examination showed 3-cm cervical dilatation with intact membranes. Regular uterine contractions every 5 minutes were also observed.

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Two‐ and three‐dimensional sonographic diagnosis of incomplete uterine scar rupture during pregnancy

Cited by 11 publications

References 8 publications

Expectant management of fetal arm extruding through a large uterine dehiscence following sonographic diagnosis at 27 weeks of gestation

Expectant management of fetal arm extruding through a large uterine dehiscence following sonographic diagnosis at 27 weeks of gestation

Prenatal Detection and Conservative Management of a Partial Fundal Uterine Dehiscence

Sonographic Findings and Surgical Management of a Uterine Rupture Associated With the Use of Misoprostol During Second-Trimester Abortion

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