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

Abstract

Cesarean section via a transverse uterine fundal incision is performed in patients with placenta previa to reduce blood loss. We describe a case of uterine rupture in a pregnant woman who previously underwent a cesarean section and recovered from cardiac arrest by multidisciplinary management.

Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study

“…In another case, the TUFI scar was not evaluated before pregnancy, and the rupture occurred at 11 weeks of gestation [ 25 ]. An additional patient experienced uterine rupture at 33 weeks of gestation [ 26 ]. This patient conceived 5 years after TUFI, but there were no retention sutures.…”

Importance of understanding the operative procedures of the transverse uterine fundal incision, postoperative management, and patient education

“…To the Editor, We read with great interest the article by Koshimizu et al 1 because it alerted us to the fact that inappropriate management of subsequent pregnancy after transverse uterine fundal incision (TUFI) can be fatal to the mother and fetus. TUFI was originally reported as an operative procedure for cesarean delivery in mothers with placenta previa that widely covers the anterior uterine wall, when placenta accreta cannot be ruled out.…”

“…The report by Koshimizu et al 1 does not describe the uterine closure technique. Also, despite the severe scar defect revealed by magnetic resonance imaging at 12 months after TUFI, the patient conceived by in vitro fertilization, which we consider to be reckless and dangerous.…”

“… 2 Since it was first reported, many mothers and fetuses have been saved by TUFI and we have reported its effectiveness. 3 However, in their recent case report, Koshimizu et al 1 did not describe any benefits of TUFI, and this might therefore mislead the readers into thinking that TUFI should not be performed because of great risks. We are concerned that the risks of TUFI are being over‐emphasized to the readers by mentioning it with cardiac arrest and perimortem cesarean delivery.…”

“…However, considering these reports, TUFI indeed requires more careful attention to the risk of uterine rupture compared with traditional low‐transverse cesarean section. Koshimizu et al 1 point out that, with TUFI, evaluating the scar thickness at the uterine fundus becomes more difficult as the gravid uterus is enlarged in a subsequent pregnancy. We believe, however, that it is more important to ascertain whether these cases of uterine rupture were treated with appropriate surgical procedures and postoperative management.…”