Spontaneous uterine rupture with amniotic sac protrusion during the third trimester of a unicornuate uterus pregnancy: A rate case report.

RATIONALE: Uterine rupture is an obstetrical emergency associated with severe maternal and fetal mortality. It is rare in the unscarred uterus of a primipara. PATIENT CONCERNS: A 25-year-old woman in her 38th week of gestation presented with slight abdominal pain of sudden onset 10 hours before. An emergency cesarean section was done. After surgery, the patient and the infant survived. DIAGNOSES: With slight abdominal pain of clinical signs, ultrasound examination showed that the amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. INTERVENTIONS: Uterine repair and right salpingectomy. OUTCOMES: After surgery, the patient and the infant survived. The newborn weighed 2600 g and had an Apgar score of 10 points per minute. Forty-two days after delivery, the uterus recovered well. LESSONS: Spontaneous uterine rupture should be considered in patients even without acute pain, regardless of gestational age, and pregnancy with abdominal cystic mass should consider the possibility of uterine rupture.

Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature.

RATIONALE: Uterine rupture during pregnancy poses significant risks to both the fetus and the mother, resulting in high mortality and morbidity rates. While awareness of uterine rupture prevention after a cesarean section has increased, insufficient attention has been given to cases caused by pregnancy following hysteroscopy surgery. PATIENT CONCERNS: We report 2 cases here, both of whom had a history of hysteroscopy surgery and presented with severe abdominal pain during pregnancy. DIAGNOSES: Both patients had small uterine ruptures, with no significant abnormalities detected on ultrasonography. The diagnosis was confirmed by a CT scan, which showed hemoperitoneum. INTERVENTIONS: We performed emergency surgeries for the 2 cases. OUTCOMES: We repaired the uterus in 2 patients during the operation. Both patients recovered well. The children survived. No abnormalities were detected during their follow-up visits. LESSONS: Attention should be paid to the cases of pregnancy after hysteroscopy.

Silent uterine rupture in the term pregnancy: Three case reports.

RATIONALE: Uterine rupture is extremely hazardous to both mothers and infants. Diagnosing silent uterine rupture in pregnant women without uterine contractions is challenging due to the presence of nonspecific symptoms, signs, and laboratory indicators. Therefore, it is crucial to identify the elevated risks associated with silent uterine rupture. PATIENT CONCERNS: on admission, case 1 was at 37 gestational weeks, having undergo laparoscopic transabdominal cerclage 8 months prior to the in vitro fertilization embryo transfer procedure, case 2 was at 38 4/7 gestational weeks with a history of 5 previous artificial abortion and 2 previous vaginal deliveries, case 3 was at 37 6/7 gestational weeks with a history of laparoscopic myomectomy. DIAGNOSES: The diagnosis of silent uterine rupture was based on clinical findings from cesarean delivery or laparoscopic exploration. INTERVENTIONS: Case 1 underwent emergent cesarean delivery, revealing a 0.25 cm × 0.25 cm narrow concave area above the Ring Ties with active and bright amniotic fluid flowing from the tear. Case 2 underwent vaginal delivery, and on the 12th postpartum day, ultrasound imaging and magnetic resonance imaging revealed a 5.8 cm × 3.3 cm × 2.3 cm lesion on the lower left posterior wall of the uterus, and 15th postpartum day, laparoscopic exploration confirmed the presence of an old rupture of uterus. Case 3 underwent elective cesarean delivery, revealing a 3.0 cm × 2.0 cm uterine rupture without active bleeding at the bottom of the uterus. OUTCOMES: The volumes of antenatal bleeding for the 3 patients were approximately 500 mL, 320 mL, and 400 mL, respectively. After silent uterine ruptures were detected, the uterine tear was routinely repaired. No maternal or neonatal complications were reported. LESSONS: Obstetricians should give particular consideration to the risk factors for silent uterine rupture, including a history of uterine surgery, such as laparoscopic transabdominal cerclage, laparoscopic myomectomy, and induced abortion.

Uterine rupture of an unscarred gravid uterus at term attributed to adenomyosis.

Uterine rupture is a rare obstetric emergency that is typically associated with the presence of scar tissue such as in the case of previous caesarean section. In this case report, a primigravid patient presented to the hospital in cardiac arrest with massive haemoperitoneum secondary to a posterior uterine rupture. The histological specimen was found to have diffuse adenomyosis at the site of rupture. On review of the literature, there is insufficient evidence to suggest we as clinicians should alter the antenatal care for patients with known adenomyosis; however, this case highlights how we should have a high index of suspicion for those presenting with signs and symptoms of uterine rupture with known adenomyosis in the absence of other risk factors.

Cornual pregnancy rupture and massive hemorrhage: A case report.

BACKGROUND: Corneal pregnancy is rare and difficult to detect in the early stages. Due to the abundant blood supply in this area, a rupture can result in massive internal bleeding, shock, and even death. Therefore, immediate surgery is necessary, and patients must replenish their blood volume as soon as possible to ensure blood supply to important organs. For those whose blood pressure cannot immediately rise, surgery should be performed while resisting shock to buy time. CASE SUMMARY: We present the case of a 34-year-old Chinese woman at 19 weeks of gestation who had a corneal pregnancy. No abnormalities were detected in the examinations in the first trimester. This patient was 19 weeks pregnant and sought medical advice due to sudden lower abdominal pain, syncope, and hemorrhagic shock. After rescue and treatment, she recovered and was discharged from the hospital, afterwards, the patient gave birth to a child 7 years later. CONCLUSION: The early diagnosis of cornual pregnancy is mainly based on ultrasound. However, there is a high incidence of missed diagnosis and misdiagnosis of this disease. Patients may face serious and life-threatening conditions in case of the rupture of cornual pregnancy. This disease can be mainly treated by surgery.

Conservative management of complete fetal expulsion into the abdominal cavity after silent uterine rupture - case report.

BACKGROUND: Clinically silent uterine rupture with complete fetal expulsion into the abdominal cavity is an extremely rare complication. Diagnosis can be difficult and the risk to the mother and fetus is high. Conservative management has been described only in a few cases of partial expulsion of the fetus so far. CASE PRESENTATION: We present a case of 43-year-old tercigravida with a history of previous laparotomic myomectomy and subsequent cesarean section. The subsequent pregnancy was complicated by uterine wall loosening and rupture at the site of the previous uterine scar after myomectomy and complete fetal expulsion into the abdominal cavity. The diagnosis was made at 24 + 6 weeks of gestation. Considering the absence of clinical symptomatology and the good condition of the fetus, a conservative approach was chosen with intensive monitoring of the maternal and fetal conditions. The pregnancy ended by elective cesarean section and hysterectomy at 28 + 0 weeks of gestation. The postpartum course was uneventful and the newborn was discharged to home care 63 days after delivery. CONCLUSIONS: Fetal expulsion into the abdominal cavity after silent uterine rupture of the scarred uterus may be accompanied by minimal symptomatology making early diagnosis difficult. This rare complication must be considered in the differential diagnosis in women after major uterine surgery. In selected cases and under conditions of intensive maternal and fetal monitoring, conservative management may be chosen to reduce the risks associated with prematurity.

Spontaneous rupture of an unscarred uterus during pregnancy: A rare but life-threatening emergency: Case series.

RATIONALE: In most cases, uterine rupture occurs during the third trimester of pregnancy or during labor. Even fewer reports have been published about the occurrence of this condition without a gynecologic history of any surgical procedure. Due to their scarcity and variable clinical presentation, early diagnosis of uterine rupture may be difficult, and if the diagnosis is not timely, the condition may be life-threatening. PATIENT CONCERNS: Herein, 3 cases of uterine rupture from a single institution are described. Three patients are at different gestational weeks and all have no history of uterine surgery. They came to the hospital due to acute abdominal pain, which is characterized by severe and persistent pain in the abdomen, with no apparent vaginal bleeding. DIAGNOSES: All 3 patients were diagnosed with uterine rupture during the operation. INTERVENTIONS: One patient underwent uterine repair surgery; while the other 2 underwent subtotal hysterectomy due to persistent bleeding and pathological examination after surgery confirmed placenta implantation. OUTCOMES: The patients recovered well after the operation, and no discomfort occurred in the follow-up. LESSONS: Acute abdominal pain during pregnancy can pose both diagnostic and therapeutic challenges. It is important to consider the possibility of uterine rupture, even in cases where there is no history of prior uterine surgery. The key to the treatment of uterine rupture is to shorten the diagnosis time as much as possible, this potential complication should be carefully monitored for and promptly addressed to ensure the best possible outcomes for both the mother and the developing fetus.

[Herniated amniotic sac through uterine dehiscence at the 30th gestational week after prior laparoscopic salpingectomy]. / Elozetes laparoszkópos salpingectomiát követo hegszétválás és buroksérv a várandósság 30. hetében.

Uterine rupture is a rare complication during pregnancy which may even lead to the death of the mother and the fetus. In this report, the management of a herniated amniotic sac associated with uterine dehiscence is presented. A 25-year-old primigravida at 30 weeks with a history of a previous unilateral salpingectomy was transferred to our hospital with the potential diagnosis of a herniated amniotic sac, which was discovered during a routine ultrasound scan. The patient had no prior complaints or any other signs that would have indicated a serious condition during her pregnancy. She underwent an emergency cesarean section and a two-layer closure of the lesion. An adequate suture during laparoscopic salpingectomy provides prevention of uterine rupture during subsequent pregnancies. A medical history with a previous laparoscopic dehiscence should necessitate a more frequent sonographic observation during pregnancy. Orv Hetil. 2023; 164(25): 988-992.

Uterine rupture in intramural ectopic pregnancy: A case report.

Intramural pregnancy is a rare form of ectopic pregnancy. It is defined by a gestation within the uterine wall, completely surrounded by myometrium and separated from the uterine cavity and the fallopian tube. We report a rare case of intramural ectopic pregnancy. If a patient has a history of intrauterine surgery or myomectomy, the possibility of intramural pregnancy, although rare, should not be ruled out.

Surgical uterus-preserving therapy after uterine rupture and haemorrhage due to placenta percreta in the first trimester following embolisation of the uterine arteries and B-Lynch suture in a previous pregnancy.

A woman in her early 30s in the 11 2/7 week of pregnancy was admitted with severe abdominal pain and emesis. One year prior, the patient had undergone hysteroscopic adhesiolysis to treat Asherman syndrome resulting from a prior pregnancy. Examination of the patient revealed a haemoperitoneum and an intact intrauterine pregnancy. Laparoscopic adhesiolysis and haemostasis was performed and the patient was transferred to the intensive care unit. Subsequent examination due to persistent abdominal pain revealed an occult iatrogenic perforation of the uterus and placenta percreta with spontaneous uterine rupture. Although treatment for placenta percreta has generally been hysterectomy, in this case, the rupture and perforation sites were resected, representing successful fertility preserving management for this oft-overlooked pregnancy complication.

First-trimester uterine rupture: a case report and systematic review of the literature.

OBJECTIVE: This study aimed to present a case of first-trimester uterine rupture and perform a systematic review to identify common presentations, risk factors, and management strategies. DATA SOURCES: Searches were performed in PubMed, Ovid, and Scopus using a combination of key words related to "uterine rupture," "first trimester," and "early pregnancy" from database inception to September 30, 2020. STUDY ELIGIBILITY CRITERIA: English language descriptions of uterine rupture at ≤14 weeks of gestation were included, and cases involving pregnancy termination and ectopic pregnancy were excluded. METHODS: Outcomes for the systematic review included maternal demographics, description of uterine rupture, and specifics of uterine rupture diagnosis and management. Data were extracted to custom-made reporting forms. Median values were calculated for continuous variables, and percentages were calculated for categorical variables. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for case reports and case series. RESULTS: Overall, 61 cases of first-trimester uterine rupture were identified, including our novel case. First-trimester uterine ruptures occurred at a median gestation of 11 weeks. Most patients (59/61 [97%]) had abdominal pain as a presenting symptom, and previous uterine surgery was prevalent (44/61 [62%]), usually low transverse cesarean delivery (32/61 [52%]). The diagnosis of uterine rupture was generally made after surgical exploration (37/61 [61%]), with rupture noted in the fundus in 26 of 61 cases (43%) and in the lower segment in 27 of 61 cases (44%). Primary repair of the defect was possible in 40 of 61 cases (66%), whereas hysterectomy was performed in 18 of 61 cases (30%). Continuing pregnancy was possible in 4 of 61 cases (7%). CONCLUSION: Uterine rupture is an uncommon occurrence but should be considered in patients with an acute abdomen in early pregnancy, especially in women with previous uterine surgery. Surgical exploration is typically needed to confirm the diagnosis and for management. Hysterectomy is not always necessary; primary uterine repair is sufficient in more than two-thirds of the cases to achieve hemostasis. Continuing pregnancy, although uncommon, is also possible.

Laparoscopic management of suspected postpartum uterine rupture: a novel approach.

BACKGROUND: Exploratory laparotomy is considered the gold standard treatment for women with suspected uterine rupture. We aimed to investigate the feasibility and safety of laparoscopy as an alternative for laparotomy for the management of hemodynamically stable women with suspected postpartum uterine rupture. STUDY DESIGN: We conducted a case series study including all women who were diagnosed with postpartum uterine rupture following vaginal delivery in a university-affiliated tertiary hospital, between November 2012 and July 2021. Until 2016, all women with suspected post-partum uterine rupture underwent laparotomy. Following 2016, a new tailored protocol based on laparoscopy for the management of postpartum uterine rupture in hemodynamically stable women was implemented. A comparison was made between women who underwent emergent laparoscopy to laparotomy. RESULTS: During the study period 17 women were diagnosed with postpartum uterine rupture. From January 2012 to January 2016, four cases of uterine rupture were diagnosed, all of whom underwent laparotomy. Since 2016, thirteen cases of uterine rupture were diagnosed, of whom seven women (54%) underwent laparoscopy and 6 (46%) laparotomy. The median time interval from delivery to surgery was 70.5 min IQR (40-179) in the laparotomy group and 202 min IQR (70-485) in the laparoscopy group. The median operative time for laparoscopic surgery was 80 min (IQR 60-114) and 78 min (IQR 58-114) for the laparotomy group. Four women who underwent laparotomy (40%) and one who underwent laparoscopy (14.2%) were admitted to the intensive care unit following surgery. Blood products transfusion was required in six women who had laparotomy (60%) and one who had laparoscopy (14.2%). Median hospitalization period was 5 d IQR (4-5) in the laparotomy group as compared to 3 d IQR (3-4) in the laparoscopy group. There were no conversions to laparotomy in the laparoscopy group. CONCLUSIONS: In hemodynamic stable women laparoscopic surgery for suspected postpartum uterine rupture is feasible and safe.

A positive urine pregnancy test with haemoperitoneum: misdiagnosed postpartum choriocarcinoma with uterine rupture mimicking ruptured ectopic pregnancy.

OBJECTIVES: Choriocarcinoma after a term pregnancy is rare and can be life-threatening, especially when it perforates the uterus, resulting in massive haemoperitoneum. As uterine rupture due to choriocarcinoma is uncommonly encountered in the clinical practice, its diagnosis is often missed or delayed. CASE PRESENTATION: We present a case of a 41-year-old para 4 + 1 who had acute abdomen and hypovolaemic shock secondary to haemoperitoneum at three months postpartum period. The urine pregnancy test was positive, and, therefore, a provisional diagnosis of a ruptured ectopic pregnancy was made. She was managed aggressively with fluids and blood product transfusion at the emergency department to achieve haemodynamic stability. Subsequently, she underwent an emergency laparotomy where intraoperatively noted a perforation at the left posterior uterine cornu with purplish tissue spillage. A wedge resection was performed, and the histopathological examination (HPE) was reported as atypical trophoblastic cells, in which choriocarcinoma could not be ruled out. The patient then underwent a total abdominal hysterectomy three weeks later. The final HPE confirmed the diagnosis of choriocarcinoma. CONCLUSIONS: The clinical presentation of postpartum choriocarcinoma can be indistinguishable from a ruptured ectopic pregnancy. A high index of suspicion is crucial to allow early diagnosis.

Scar Pregnancy a Diagnostic Conundrum: A Case Report.

Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific  pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortality.

Recurrent uterine rupture in third trimester of pregnancy.

We report a case of recurrent upper segment uterine rupture in a 31-year-old woman at 32+5/40 weeks of gestation. She had fundal uterine rupture 3 years ago in her first pregnancy at 40 weeks of gestation. There was no history of uterine malformation or prior uterine surgery. However, we noted that she had had three laparoscopic procedures for endometriosis treatment. She was scheduled to have an elective repeat caesarean section at 34+6/40 weeks of gestation in the index pregnancy. Unfortunately, she presented at 32+5/40 weeks with features of acute abdomen and signs of fetal distress. She had a category 1 caesarean section and was found to have fundal uterine rupture at the same site. She had a smooth uneventful recovery following a timely intervention and discharged home on day 5 postoperatively in a good condition with her baby girl.

Shock caused by spontaneous rupture uterine vessels during puerperal period: a case report and literature review.

Hemoperitoneum caused by spontaneous rupture of uterine vessels during delivery is relatively rare in obstetric hemorrhage, and even rarer during the puerperal period. It can be life-threatening without timely diagnosis and treatment; therefore, the literature on this topic is very scarce. To explore its etiology and identify its diagnosis and treatment principle, we are reporting a case of shock caused by spontaneous rupture of uterine vessels admitted in our hospital. Its etiology is still unknown, its presenting symptoms are commonly unspecific, and its diagnosis is often made during the surgery. The rupture of uterine vessels during pregnancy should be differentiated from placental abruption, uterine rupture, placenta implantation through the uterus, and abdominal organ rupture. Active and timely operative intervention can prevent the mortality. This case stresses the need for careful post-delivery monitoring for revealed postpartum hemorrhage. We will discuss possible etiologies of uterine vessels rupture during pregnancy, associated imaging findings, and management options.

Diagnosis and management of rudimentary horn pregnancy rupture, misinterpreted as bicornuate uterus in the 14th week of pregnancy.

We present a 26-year-old primigravida with rudimentary horn pregnancy rupture at 14 weeks of pregnancy. Uterine anomaly was first diagnosed at the time of nuchal translucency scan and was presumed to be a bicornuate uterus with normal intrauterine pregnancy in the right horn. One day later, she was admitted to our department with abdominal pain, shortly leading to massive hemoperitoneum and hypovolemic shock. Uterine rupture was confirmed ultrasonically, followed by immediate laparotomy. Ruptured rudimentary horn with already expulsed pregnancy was encountered during surgery. Despite significant advances in ultrasonography, diagnosis of prerupture stage remains controversial. However, high mortality of the condition should ensure low threshold for surgical exploration.

Osteogenesis imperfecta type I: The role of deep phenotyping in a patient with a ruptured uterus.

As molecular diagnosis of Osteogenesis Imperfecta has become more accessible, there is an increasing ability to consider additional techniques to undertake deep phenotyping of the patient. In this report, we present the details of a female patient with type I Osteogenesis Imperfecta caused due to a pathogenic COL1A1 variant, who suffered from uterine rupture during labour in her second pregnancy, at age 33. Her presentation, patient journey, and histological results are described. Collagen flowers were identified with electron microscopy of a skin biopsy, and the significance of these are explored. Two other recorded cases of women with Osteogenesis Imperfecta who developed uterine rupture are discussed. This report demonstrates the potential role for ultrastructural tissue examination and deep phenotyping, to allow further insights into the relationship between genotype and phenotype.

Spontaneous Uterine Rupture in the Second Trimester in a Patient With Previous Pelvic Radiotherapy in Childhood: A Case Report.

BACKGROUND: Pelvic irradiation in childhood may result in abnormal uterine function. Poor obstetric outcomes have been reported in these patients. CASE: A 30-year-old woman with a previous midtrimester miscarriage, G2, P0, presented at 234 weeks gestation with acute abdominal pain and signs of hemodynamic instability. The patient was treated in childhood for Ewing sarcoma of the pelvis. Spontaneous uterine rupture was diagnosed. A supracervical hysterectomy with intrauterine fetus was performed. CONCLUSION: A high index of suspicion is needed in primigravidas with risk factors for uterine rupture. Pelvic radiotherapy in childhood may be a risk factor.