Rotura uterina durante el segundo trimestre de gestación asociado a placenta percreta: presentación de un caso y revisión de la literature / Uterine rupture during the second trimester of pregnancy associated with placenta percreta: presentation of a case and review of the literature

OBJETIVO: Reportar el manejo de un caso de rotura uterina asociado a percretismo placentario en el segundo trimestre de gestación; y realizar una revisión de la literatura acerca del diagnóstico y tratamiento de esta condición. PRESENTACIÓN DEL CASO: Paciente de 31 años con diagnóstico intraoperatorio de rotura uterina asociada a percretismo placentario a la semana 21 de gestación. Requirió manejo quirúrgico inmediato por abdomen agudo, presentando shock hipovolémico y muerte fetal in útero. Materiales y métodos: Se realizó una búsqueda de la literatura registrada en las bases de datos entre el año 1995 y 2017 y publicados en inglés y español. Se incluyeron los reportes de y series de caso y artículos de revisión, con relación al diagnóstico prenatal y tratamiento. RESULTADOS: La mayoría de los casos reportados de rotura uterina se describen en mujeres con rotura uterina por percretismo entre la semana 9 y 34 de gestación. El tratamiento es quirúrgico en la gran mayoría de casos y su abordaje dependerá de los hallazgos intraoperatorios y condiciones médicas asociadas. CONCLUSIÓN: El acretismo placentario presentado en etapas tempranas de la gestación es rara, sin embargo, se debe sospechar según hallazgos clínicos y paraclínicos. El manejo debe estar dirigido de acuerdo al grado de invasión placentaria y situación hemodinámica, la mayoría de las veces es quirúrgico y realizado por un equipo interdisciplinario.

OBJECTIVE: To report the management of a case of uterine rupture associated with placental percreta in the second trimester of pregnancy, and to make a review of the literature about the diagnosis and treatment of this condition. PRESENTACION OF THE CASE: A 31-year-old patient with intraoperative diagnosis of uterine rupture associated with placental percretism at week 21 of gestation, who required immediate surgical intervention for acute abdomen, which developed in a hypovolemic shock and fetal death in utero. MATERIALS AND METHODS: A Research was done of the literature registered in the databases between 1995 and 2017, and published in English and Spanish. We included case reports and case series and review articles, in relation to prenatal diagnosis and treatment. RESULTS: The majority of reported cases of uterine rupture that are found in women with this condition are due to percretism between week 9 and 34 of gestation. The treatment is surgical in the great number of cases, which procedure will follow depending on the intraoperative findings and associated medical conditions. CONCLUSION: Placental accreta presented at early stages of gestation is rare, however it should be taken into account while considering the clinical and paraclinical findings. The treatment must be directed accordingly to the degree of placental invasion and hemodynamic situation, although most of the time will lead to surgery performed by an interdisciplinary team.

Ruptured Uterus in Pregnancy: A Case Report.

Spontaneous uterine rupture in pregnancy is a rare phenomenon especially in the second trimester. When it occurs one has to suspect placenta percreta. Here we had such a case in a 32-year-old lady who had previous caesarean section for fetal distress 7 years ago. Now she got admitted with a history of 4 months of amenorrhea with severe pallor and hypotension. She did not have any uterine contraction before admission, and there is no history suggestive of any interference with the present pregnancy. On opening the abdomen, there was hemoperitoneum and an intact gestational sac was found protruding through the rent at right side of the fundus. Total abdominal hysterectomy was done, and the placenta was found to be placenta percreta, that was confi rmed by histopathological examination.

Rotura e deiscência de cicatriz uterina: estudo de casos em uma maternidade de baixo risco do sudeste brasileiro / Rupture and dehiscence of uterine scar: cases study at a low-risk maternity in the Brazilian Southeast

OBJETIVO: Analisar os casos de rotura uterina e deiscência de cicatriz uterina ocorridos em uma maternidade de baixo risco e apontar possibilidades de aprimoramento na abordagem dessas complicações. MÉTODOS: Foi realizado um estudo descritivo em uma maternidade de baixo risco com 30 leitos, que presta assistência às usuárias do sistema público de saúde. A investigação foi realizada por meio de busca dos casos em livros de registros de sala de parto e posterior leitura dos prontuários para coleta dos dados. As informações foram inseridas em formulário previamente elaborado para este estudo. Foram incluídos os casos de rotura uterina e deiscência de cicatriz uterina diagnosticados no período de 1998 a 2012, avaliados incidência, aspectos relacionados aos fatores de risco e diagnóstico, associação com o uso de misoprostol e ocitocina e desfechos observados. RESULTADOS: No período mencionado foram registrados 39.206 partos nessa instituição. A cesárea foi a conduta adotada em 10 mil partos, o que equivale a uma taxa de 25,5%. Foram identificados 12 casos de rotura uterina e 16 de deiscência de cicatriz uterina. Os resultados mais relevantes foram a alta mortalidade perinatal associada à rotura uterina e o insucesso no diagnóstico da complicação. Não foi possível demonstrar associações com o uso de misoprostol ou ocitocina. CONCLUSÃO: Os desfechos adversos da rotura uterina podem ser minimizados se esforços forem direcionados para melhorar o desempenho diagnóstico das equipes assistentes. .

PURPOSE: To evaluate the cases of uterine rupture and dehiscence of the uterine scar at a low-risk maternity and to point out possibilities for an improved approach to these complications. METHODS: A descriptive study was conducted at a 30-bed low-risk maternity hospital that provides care to users of the public health system. The investigation was carried out by searching for cases in the delivery room registry book and later reading the medical records in order to obtain the data. The information was inserted on a form previously elaborated for this study. Cases of uterine rupure and dehiscence of the uterine scar diagnosed from 1998 to 2012 were included, with the determination of incidence, aspects related to risk factors and diagnosis, association with the use of misoprostol and oxytocin, and the outcomes observed. RESULTS: A total of 39,206 deliveries were performed in this maternity during the study period, with 12 cases of uterine rupture and 16 cases of dehiscence of uterine scar being observed. The most relevant results were a high perinatal mortality associated with uterine rupture and the unsuccessful diagnosis of this complications. It was not possible to demonstrate an association with the use of misoprostol or oxytocin. CONCLUSION: The adverse outcomes of uterine rupture could be minimized if efforts were directed at improving the diagnostic performance of the assisting teams. .

Uterine rupture revisited: predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey

To determine the predisposing factors, modes of clinical presentation, management modalities and fetomaternal outcomes of uterine rupture cases at a tertiary care center in Turkey. A 14-year retrospective analysis of 61 gravid [> 20 weeks of gestation] uterine rupture cases between January 1998 to March 2012 was carried out. The incidence of ruptured uteri was calculated to be 0.116%. Persistence for vaginal delivery after cesarean was the most common cause of uterine rupture [31.1%]. Ablatio placenta was the most common co-existent obstetric pathology [4.9%]. Bleeding was the main symptom at presentation [44.3%] and complete type of uterine rupture [93.4%] was more likely to occur. Isthmus was the most vulnerable part of uterus [39.3%] for rupture. The longer the interval between rupture and surgical intervention, the longer the duration of hospitalization was. Older patients with increased number of previous pregnancies were likely to have longer hospitalization periods. Rupture of gravid uterus brings about potentially hazardous risks. Regular antenatal care, hospital deliveries and vigilance during labor with quick referral to a well-equipped center may reduce the incidence of this condition

Rotura uterina espontánea en el primer trimestre del embarazo / Uterine rupture spontaneously in the first quarter of pregnancy

La rotura uterina es una complicación obstétrica infrecuente, pero potencialmente letal para la madre y el feto. Ocurre principalmente durante el segundo o tercer trimestre, asociada a factores de riesgo, entre los que destaca la cirugía uterina previa. Su aparición durante el primer trimestre es excepcional, constituyendo un desafío médico por su difícil diagnóstico diferencial y controversial manejo. Se presenta el caso de una paciente con rotura espontánea de útero grávido de 10 semanas de gestación, portadora de triple cicatriz anterior. El diagnóstico fue intraoperatorio, tras la descompensación hemodinámica de la paciente. El manejo incluyó el cierre primario de la lesión y observación posterior. Al sexto día se constata la muerte fetal y se efectúa el vaciamiento de la cavidad uterina. La falla de las medidas conservadoras obligó finalmente a realizar una histerectomía obstétrica. La histopatología informó placenta acreta.

Uterine rupture is an uncommon obstetric event, but still potentially lethal for the mother and the fetus. It presents mainly during the second or third trimester and is associated with several riskf actors, being a previous uterine scar the most important of them. Its presentation during the first trimester is exceptional, and it constitutes a medical challenge, because of its difficult differential diagnosis and controversial management. A case of a multiparous, previous triple scar woman is presented, with a spontaneous uterine rupture at 10 weeks of pregnancy. In this case the diagnosis was made during surgery, after the patient's hemodynamic decompensation. The management included primary closure of the lesion and observation; when fetal death was confirmed, dilatation and curettage of the cavity had to be performed. Because of the failure of conservative management, an obstetric hysterectomy was carried out. Histopathology reported placenta accreta.

Rudimentary horn pregnancy: prerupture diagnosis and management.

A unicornuate uterus with a rudimentary horn is a rare mullerian abnormality which may cause many gynecological and obstetrical complications. Rupture of pregnant rudimentary horn in the second trimester is the usual presentation, resulting in maternal morbidity and even mortality.

Spontaneous Uterine Rupture in the First Trimester: A Case Report

Uterine rupture is one of the most feared obstetric complications affecting the pregnant woman and fetus. Most of the cases have various risk factors and mainly occur during the second or third trimester. However, spontaneous uterine rupture during the first trimester is extremely rare. We experienced a case of spontaneous uterine rupture in a 36-yr-old multiparous woman without definite risk factors. The initial impression was a hemoperitoneum of an unknown origin with normal early pregnancy. Intensive surgical method would be needed for accurate diagnosis and immediate management in bad situation by hemoperitoneum even though a patient was early pregnancy.

Incidencia de rotura uterina en el Hospital Dr. Patrocinio Peñuela Ruíz 1982-2003 / Incidence of uterine rupture at the Hospital Dr. Patrocinio Peñuela Ruíz 1982-2003

El presente es un estudio retrospectivo y longitudinal realizado en el Hospital Patrocinio Peñuela Ruíz, San Cristóbal, Estado Táchira, basado en la revisión de las historias clínicas entre los años 1982-2003 con diagnóstico de Rotura Uterina. Encontrándose una Tasa de 0.22 por 1000 partos (1 de 4512 partos). El 50 por ciento pertenecia al grupo 1 a 4 paras. La edad gestacional predominante fue 37-41 semanas 83.33 por ciento. El 66.66 por ciento de los casos tenían útero indemne, el factor determinante más frecuente fue el uso de Oxitócico (66.66 por ciento), el 50 por ciento de las rupturas fueron espontáneas, la Histeretomía fue usada en un 50 por ciento, el diagnóstico intraoperatorio fue del 83.33 por ciento, la mortalidad fetal fue del 33.33 por ciento

Ruptura uterina espontanea por placenta percreta

La rotura uterina en un útero sin cicatriz previa, y temprano en el tercer trimestre, es un evento raro. Se expone el caso clínico de una paciente que se presenta con abdomen agudo, cursando embarazo de aproximadamente 25 semanas, se realiza laparotomía exploradora encontrando hemoperitoneo, feto y placenta libres en la cavidad peritoneal y útero roto en el fondo invadido por la placenta, que compromete epiplón mayor. Se realiza histerectomía y se confirma el diagnóstico con biopsia.

Rupture uterus--changing Indian scenario.

A total of 60 cases of rupture uterus managed in last five years in the department of obstetrics and gynaecology at the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi were reviewed. Of these 77% cases reported to the hospital with rupture uterus while in 23% cases rupture occurred after admission. The factor responsible for rupture in admitted patients was either oxytocin induction/augmentation in scarred uterus or obstetrical manipulation in unscarred uterus; 80% cases were totally unsupervised during antenatal period. Previous uterine scar was responsible for rupture in as high as 63.3% cases. The commonest previous surgery was caesarean section mostly for non-recurrent causes. Obstructed labour was responsible for rupture in 26.6% cases while traumatic rupture was seen in 10% cases. Repair of uterine rent was performed in 54% cases while rest required hysterectomy. Bladder injury was associated in 9 cases and was repaired at the time of laparotomy. Maternal mortality was 3.33% and foetal mortality was 78.66%. The changing trends observed in the present study are those of low maternal mortality and decreasing incidence of obstructed labour in the aetiology of rupture uterus.

Rupture of left horn of bicornuate uterus at twenty weeks of gestation.

Rupture uterus in nulliparous patients is generally associated with mullerian anomalies. A case of 23 years primigravida with 19 weeks gestation presenting with features of rupture is reported here. Ultrasound helped in the diagnosis of left horn of bicornuate uterus. After exploration, right ruptured horn was excised. The incidence, diagnosis and management of such cases is discussed.

Análisis de las indicaciones para histerectomías obstétricas / Analysis of the indications to obstetrical hysterectomies

Analizar las indicaciones, evolución y complicaciones de las histerectomías. Estudio analítico, crítico y retrospectivo de 21 histerectomías obstétricas realizadas en el período 1990-1996, y correlación con indicación, evolución y complicaciones. Las pricipales indicaciones fueron: rotura uterina, hematoma del ligamento ancho; sepsis; perforación uterina, hipotonía uterina; hipotonía uterina; lesión transoperatoria de arteria uterina e infiltrado uterino. El análisis de estas indicaciones mostró que 14 casos pudieron haberse resuelto sin la necesidad de realizar una histerectomía. La decisión de realizar histerectomía en la emergencia obstétrica debe ser analizada cuidadosamente antes de tomar una conducta apresurada, debido a que se trata de una intervención difícil por las modificaciones que sobre la anatomía de la región produce el embarazo y en muchas ocasiones sus complicaciones pueden superar sus beneficios

Rupture of the gravid uterus. a retrospective five years study in Mosul

Fifty cases of ruptured gravid uterus dealt with in the Mosul Maternity Hospital from January 1979 to December 1983 were studied retrospectively. The overall incidence was 1.1 per 1000 live births. The common etiologic factors were cephalic malposition, grand multiparty, obstetric interference and lack of antenatal care. Maternal and foetal mortality were 26% and 96% respectively. Twenty nine patients [58%] underwent abdominal hysterectomy, and 18 patients [36%] had repair of the uterus, of whom 6 [12%] had tubal ligation

Rotura uterina

La rotura uterina se convierte, por la elevada mortalidad materno-fetal inherente a su ocurrencia, en la principal y más grave complicación obstétrica, por lo cual es de suprema importancia recalcar el primordial papel que desempeña el control prenatal orientado a identificar sus principales factores de riesgo. El presente artículo tien como finalidad realizar una exhaustiva revisión de los principales factores predisponenetes, así como orientar su diagnostico y tratamiento de una manera práctica.

Uterine rupture and ectopic pregnancy in a mare

A case of uterine rupture and ectopic pregnancy in a mare was diagnosed. The physical examination showed an alert and responsive animal. The rectal examination revealed a nearly full term alive fetus in the abdominal cavity still surrounded by all of the placental membranes. Vaginal examination showed a widely dilated and an empty uterus. After examination abdominal contraction became more stronger, and uterine prolapse occurred. An incision was made in the prolapsed uterus to pull the fetus out, and hysterectomy was performed

Rupture of the pregnant uterus: Ramathibodi's experience 1981-1990.

A total of seven women had uterine rupture at Ramathibodi Hospital, Bangkok, between 1981-1990. The incidence was 1 per 9,908 deliveries or 1.009 per 10,000 deliveries. All were related to oxytocic drug administration and two of them had induction with prostaglandins. The intraoperative and postoperative problems were intraoperative hypotension (57%), febrile morbidity (28%) and wound dehiscence (12.5%). Fetal mortality was 43 percent and there was no maternal death.

Rotura uterina (espontânea na gestaçäo de 29 semanas) / Uterine rupture (spontaneous in pregnancy of 29 weeks)

O trabalho tece consideraçöes sobre a rotura uterina espontânea durante a gestaçäo: incidência classificaçäo, etiopatogenia quadro clínico, prognóstico e tratamento. A presenta relato de um caso de rotura uterina espontânea, ocorrida com 29 semanas de gestaçäo, salientando os aspectos clínicos laboratoriais, cirúrgicos e os resultados perinatais