Clinical analysis of complete uterine rupture during pregnancy.

BACKGROUND: Uterine rupture in pregnant women can lead to serious adverse outcomes. This study aimed to explore the clinical characteristics, treatment, and prognosis of patients with complete uterine rupture. METHODS: Data from 33 cases of surgically confirmed complete uterine rupture at Chenzhou No.1 People's Hospital between January 2015 and December 2022 were analyzed retrospectively. RESULTS: In total, 31,555 pregnant women delivered in our hospital during the study period. Of these, approximately 1‰ (n = 33) had complete uterine rupture. The average gestational age at complete uterine rupture was 31+4 weeks (13+1-40+3 weeks), and the average bleeding volume was 1896.97 ml (200-6000 ml). Twenty-six patients (78.79%) had undergone more than two deliveries. Twenty-five women (75.76%) experienced uterine rupture after a cesarean section, two (6.06%) after fallopian tube surgery, one (3.03%) after laparoscopic cervical cerclage, and one (3.03%) after wedge resection of the uterine horn, and Fifteen women (45.45%) presented with uterine rupture at the original cesarean section incision scar. Thirteen patients (39.39%) were transferred to our hospital after their initial diagnosis. Seven patients (21.21%) had no obvious symptoms, and only four patients (12.12%) had typical persistent lower abdominal pain. There were 13 cases (39.39%, including eight cases ≥ 28 weeks old) of fetal death in utero and two cases (6.06%, both full term) of severe neonatal asphyxia. The rates of postpartum hemorrhage, blood transfusion, hysterectomy were 66.67%, 63.64%, and 21.21%. Maternal death occurred in one case (3.03%). CONCLUSIONS: The site of the uterine rupture was random, and was often located at the weakest point of the uterus. There is no effective means for detecting or predicting the weakest point of the uterus. Rapid recognition is key to the treatment of uterine rupture.

Spontaneous second trimester rupture of a previous caesarean section scar: A case report.

Spontaneous uterine rupture before the onset of labour is rare in pregnancy especially before the third trimester. It is life threatening with devastating consequences to the mother and fetus. We report a case of spontaneous second trimester uterine rupture in a multipara with a previous uterine scar with the aim of creating awareness and sharing the challenges in diagnosis and management of this unusual complication of pregnancy. A 34-year-old woman with two previous deliveries presented at 16 weeks gestation with abdominal pain and vaginal bleeding of one day duration. At presentation, she was pale and in shock. There was generalized abdominal tenderness with guarding and rebound tenderness. At laparotomy, there was uterine rupture involving the lower segment with right lateral upward extension which was repaired. She remained stable at the follow up visit. In conclusion, Spontaneous uterine rupture of a previous caesarean section scar in the second trimester is rare. The diagnosis should be considered in a woman with previous caesarean section who experience an acute abdomen in the second trimester of pregnancy.

La rupture utérine spontanée avant le début du travail est rare pendant la grossesse, surtout avant le troisième trimestre. Elle met la vie en danger et entraîne des conséquences dévastatrices pour la mère et le fœtus. Nous rapportons un cas de rupture utérine spontanée au deuxième trimestre chez une multipare présentant une cicatrice utérine antérieure dans le but de sensibiliser et de partager les défis du diagnostic et de la prise en charge de cette complication inhabituelle de la grossesse. Une femme de 34 ans ayant déjà accouché deux fois s'est présentée à 16 semaines de gestation avec des douleurs abdominales et des saignements vaginaux d'une durée d'un jour. Lors de la présentation, elle était pâle et sous le choc. Il y avait une sensibilité abdominale généralisée avec une sensibilité de garde et de rebond. Lors de la laparotomie, il y a eu une rupture utérine impliquant le segment inférieur avec extension latérale droite vers le haut qui a été réparée. Elle est restée stable lors de la visite de suivi. En conclusion, la rupture utérine spontanée d'une cicatrice de césarienne antérieure au deuxième trimestre est rare. Le diagnostic doit être envisagé chez une femme ayant déjà subi une césarienne et présentant un abdomen aigu au cours du deuxième trimestre de la grossesse.

[Maternal mortality due to obstetric haemorrhage in France 2016-2018]. / Mortalité maternelle par hémorragie obstétricale en France 2016­2018.

Between 2016 and 2018, 20 maternal deaths were related to obstetric haemorrhage, excluding haemorrhage in the first trimester of pregnancy, representing a mortality ratio of 0.87 per 100,000 live births (95% CI 0.5 -1.3). Obstetric haemorrhage is the cause of 7.4% of all maternal deaths up to 1 year, 10% of maternal deaths within 42days, and 21% of deaths directly related to pregnancy (direct causes). Between 2001 and 2018, maternal mortality from obstetric haemorrhage has been considerably reduced, from 2.2deaths per 100,000 live births in 2001-2003 to 0.87 in the period presented here. Nevertheless, obstetric haemorrhage is still one of the main direct causes of maternal death, and remains the cause with the highest proportion of deaths considered probably (53%) or possibly (42%) preventable according to the CNEMM's collegial assessment (see chapter 3). The preventable factors reported are related to inadequate content of care in 94% of cases and/or organisation of care in 44% of cases. In this triennium, maternal death due to haemorrhage occurred mainly in the context of caesarean delivery (65% of cases, i.e. 13/20), and mostly in the context of emergency care (12/13). The main causes of obstetric haemorrhage were uterine rupture (6/20) in unscarred uterus or in association with placenta accreta, and surgical injury during the caesarean delivery (5/20). Every maternity hospital, whatever its resources and/or technical facilities, must be able to plan any obstetric haemorrhage situation that threatens the mother's vital prognosis. Intraperitoneal occult haemorrhage following caesarean section and uterine rupture require immediate surgery with the help of skilled surgeon resources with early and appropriate administration of blood products.

Uterine rupture in the first trimester: a case report and review of the literature.

BACKGROUND: Uterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, which is mostly due to catastrophic bleeding. First trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding such as an ectopic pregnancy. We present a case of first trimester scar dehiscence and conduct a literature review of this rare condition. CASE PRESENTATION: A 39-year-old African patient with four previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. She had two previous histories of third trimester uterine rupture in previous pregnancies with subsequent hysterotomies and repair. She underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently done. CONCLUSION: In conclusion, the case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The risk factors, clinical presentation, diagnostic imaging, and management outlined may help in early identification and management of this rare but life threatening condition.

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.

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.

A propósito de un caso: presentación atípica de rotura uterina / A case report: unusual presentation of uterine rupture

RESUMEN La rotura del útero gestante se define como una solución de continuidad patológica de la pared uterina, situada con mayor frecuencia en el segmento inferior. La rotura de un útero intacto es muy rara, su incidencia está estimada entre 1/5700 y 1/20000 embarazos. Su prevalencia ha aumentado dado el incremento de parto vaginal con cesárea anterior. Actualmente oscila entre el 0.3 y el 1 %, siendo mayor en mujeres en las que tiene lugar un intento de parto vaginal tras cesárea (0,78%) que en aquellas en las que se lleva a cabo una cesárea electiva (0,22%). En cuanto a su diagnóstico, suele ser precoz, dada la clínica de gravedad con la que debutan. En este caso se presenta una evolución atípica de rotura uterina, donde la paciente se mantiene asintomática hasta que acude a urgencias cinco días después del parto con fiebre y dolor abdominal; gracias a la ecografía abdominal y trans-vaginal se pudo establecer rápidamente el diagnóstico y así proceder a su inmediata reparación quirúrgica.

ABSTRACT Rupture of the pregnant uterus is defined as a solution of pathological continuity of the uterine wall, most often located in the lower segment. The rupture of an intact uterus is very rare, its incidence is estimated between 1/5700 and 1/20000 pregnancies. Its prevalence has increased given the increase in vaginal delivery with previous caesarean section. Currently, it ranges between 0.3 and 1%, being higher in women with a vaginal delivery after caesarean section (0.78%) than in those who undergo an elective caesarean section (0.22%). Their diagnosis is usually early given by the severity of the debut. In this case, there is an atypical evolution of uterine rupture where the patient remains asymptomatic until she goes to the emergency room five days after delivery with fever and abdominal pain; Because of the abdominal and transvaginal ultrasound, the diagnosis could be quickly established and thus proceed to immediate surgical repair.

Investigación de incidencia y complicaciones de histerectomía de emergencia en periparto / Investigation of Incidence and Complications of Emergency peripartum hysterectomy

Introducción: La histerectomía periparto de emergencia es una cirugía de alto riesgo, que se realiza mayoritariamente después de un parto vaginal o cesárea. Dada la importancia de las complicaciones y la mortalidad de las embarazadas para el sistema de salud, el presente estudio tuvo como objetivo investigar la incidencia y las complicaciones de la histerectomía periparto de emergencia en los hospitales generales y docentes de la Universidad de Ciencias Médicas de Zahedan. Materiales y Métodos: En este estudio descriptivo-analítico transversal, luego de obtener la aprobación del Comité de Ética, se investigó la historia clínica de las pacientes con histerectomía periparto de emergencia ingresadas en el hospital Ali ibn Abitaleb de Zahedan para la interrupción del embarazo durante 2017-2018. fueron estudiados. Después de evaluar las características demográficas, incluida la edad, la educación y la ocupación, se investigaron las causas y las complicaciones de la histerectomía de emergencia. Finalmente, los datos fueron analizados por el software SPSS.Resultados: De 2438 casos, se investigaron 50 casos de histerectomía. La edad media de las madres y el número medio de embarazos fue de 31,06 ± 5,21 y 5,72 ± 2,31, respectivamente. En este estudio, se registraron 35 cesáreas (70%) y 15 partos vaginales normales (30%), y solo el 2% condujo a una histerectomía de emergencia. Las causas más comunes de histerectomía de emergencia incluyeron placenta accreta (28%), atonía uterina (24%) y rotura uterina (20%). Las complicaciones también incluyeron fiebre (24%), coagulopatía (14%) e infección de la herida (12%). Conclusión: la placenta accreta y la atonía uterina son las causas más importantes de histerectomía. Las complicaciones más comunes de la histerectomía de emergencia son fiebre, coagulopatía e infecciones de heridas. Una disminución en el parto por cesárea electiva y un mayor fomento del parto vaginal natural podrían reducir significativamente la incidencia de histerectomía periparto y la mortalidad materna

Introduction: The emergency peripartum hysterectomy is a high-risk surgery, which is mostly performed after vaginal delivery or Caesarean section. Given the importance of complications and mortality of pregnant mothers for the health system, the present study aimed to investigate the incidence and complications of emergency peripartum hysterectomy in general and teaching hospitals of Zahedan University of Medical Sciences. Materials and Methods: In this cross-sectional descriptive-analytic study, after obtaining the Ethics Committee approval, the medical record of patients with emergency peripartum hysterectomy admitted to Ali ibn Abitaleb hospital of Zahedan for pregnancy termination during 2017-2018 were investigated. were studied. After evaluating demographic characteristics, including age, education, and occupation, causes, and complications of emergency hysterectomy were investigated. Finally, data were analyzed by SPSS software. Results: Out of 2438 cases, 50 cases of hysterectomy were investigated. The mean age of mothers and the average number of pregnancies was 31.06±5.21 and 5.72±2.31, respectively. In this study, 35 caesarean sections (70%) and 15 normal vaginal delivery (30%) were recorded, with only 2% leading to emergency hysterectomy. The most common causes of emergency hysterectomy included placenta accreta (28%), uterine atony (24%), and uterine rupture (20%). The complications also included fever (24%), coagulopathy (14%), and wound infection (12%). Conclusion: Placenta accreta and uterine atony are the most important causes of hysterectomy. The most common complications of emergency hysterectomy are fever, coagulopathy, and wound infections. A decrease in elective caesarean delivery and further encouraging to natural vaginal delivery could significantly reduce the incidence of peripartum hysterectomy and maternal mortality

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.

Rotura uterina por percretismo placentario a las 17 semanas de gestación / Uterine rupture due to placenta percreta at 17 weeks of pregnancy

La rotura uterina durante la gestación es una complicación poco frecuente, con elevada morbimortalidad materna y fetal. Generalmente se presenta en etapas avanzadas de la gestación. En estadios iniciales es una complicación extremadamente infrecuente. La sospecha, abordaje diagnóstico y terapéutico rápido minimiza la mortalidad materna y fetal. Se presenta un caso clínico de rotura uterina en el segundo trimestre, con diagnóstico de placenta pércreta. Como antecedentes destacaron 2 abortos asociados a legrado uterino. El estudio ecográfico de urgencia informó de la existencia de líquido libre peritoneal. Se intervino quirúrgicamente y se observó una rotura uterina fúndica. La paciente precisó de histerectomía abdominal (AU)

Uterine rupture during pregnancy is a rare complication with high maternal and foetal morbidity and mortality. This complication usually occurs in the advanced stages of pregnancy and is extremely rare in the early stages. A high index of suspicion, rapid diagnosis and prompt treatment minimizes maternal and fetal mortality. We present a case of uterine rupture in the second trimester of pregnancy, which was diagnosed as placenta percreta. The patient had a history of two abortions with curettage. Emergency ultrasonography revealed free peritoneal fluid. Surgery was performed and a fundal uterine rupture was observed. The patient required abdominal hysterectomy (AU)

Dehiscencia uterina diagnosticada un mes postparto: presentación de un caso y revisión bibliográfica / Uterine dehiscence discovered one month after delivery: case report and literature review

La rotura uterina es una complicación obstétrica cuyas consecuencias pueden ser graves. Se diagnostica principalmente antes o durante el trabajo de parto en mujeres con antecedente de cesárea y una extracción rápida del feto es necesaria. Sin embargo, pocos casos de dehiscencia uterina son diagnosticados a distancia del parto. Presentamos el caso de una paciente con útero cicatrizado, que consulta por metrorragia 27 días después de parto por vía vaginal, en la que se diagnosticó una dehiscencia uterina con consecuente histerectomía abdominal a través de una incisión de Pfannenstiel. Por medio de este caso se evaluarán los signos y síntomas para el diagnóstico temprano de una dehiscencia, permitiendo así proporcionar el tratamiento más conservador posible (AU)

Uterine rupture is an uncommon but potentially devastating maternal and obstetric complication that is usually diagnosed in women with a prior caesarean delivery before or during labour, leading to an emergency foetal extraction. However, there are very few reports of uterine rupture diagnosed in the postpartum period. We report the case of a patient with a scarred uterus who presenting with metrorrhagia 27 days after a vaginal delivery. A diagnosis of uterine dehiscence was made, requiring an abdominal hysterectomy through Pfannenstiel incision. Through this case we highlight the symptoms and signs to establish an early diagnosis, which allow provision of the most conservative treatment possible (AU)

Histerectomía periparto en el Hospital General Universitario de Elche / Peripartum hysterectomy in the Hospital General Universitario de Elche (Spain)

El propósito de este estudio fue determinar la incidencia, indicaciones, resultados maternos y complicaciones de la histerectomía periparto en nuestro medio. Para ello se analizaron retrospectivamente 17 casos de histerectomía periparto ocurridos entre enero de 2001 y diciembre de 2005 en el Servicio de Obstetricia y Ginecología del Hospital General Universitario de Elche. La incidencia de la intervención fue de 1,3 por 1.000 nacimientos. Las indicaciones más frecuentes fueron: atonía uterina (53%), acretismo placentario (23%) y rotura uterina (12%). No hubo muertes maternas. Hemorragia/coagulopatía (53%) e infección (24%) fueron las complicaciones habituales. Más de un 90% precisaron transfusión. La histerectomía periparto se acompañó de una importante morbilidad. La identificación previa de los probables casos puede permitir mejorar los resultados mediante la preparación adecuada para esa eventualidad y la participación de obstetras más experimentados

The aim of this study was to determine the incidence, indications, maternal outcomes and complications of peripartum hysterectomy in our environment. For this purpose we retrospectively analyzed 17 cases of peripartum hysterectomy performed at the Obsterine rupture (12%). There were no maternal deaths. The most common complications were hemorrhage/coagulopathy (53%) and infection (24%). More than 90% of the patients required transfusion Peripartum hysterectomy was associated with significant morbidity. Prior identification of probable cases can improve the results by allowing adequate preparation for this procedure and the involvement of the most experienced obstetricians

Rotura uterina espontánea durante el segundo trimestre asociado a placenta pércreta. Caso clínico y revisión de la literatura / Spontaneous uterine rupture in the second trimester associated with placenta percreta: Case report and literature review

Caso de rotura uterina por placenta pércreta confirmado histológicamente a las 20 semanas de gestación y revisión bibliográfica de casos clínicos publicados de menos de 28 semanas (AU)

We report a case of histologically-confirmed uterine rupture due to placenta percreta at 20 weeks of gestation. We provide a review of case reports of this event occurring at less than 28 weeks of pregnancy (AU)

Causa infrecuente de abdomen agudo hemorrágico / Rare cause of acute abdomen bleeding

La rotura espontanea de vasos uterinos es una rara causa de abdomen agudo hemorrágico durante el embarazo y una complicación potencialmente mortal. Las manifestaciones clínicas son: dolor abdominal súbito, shock hipovolémico y caída de hematocrito. Objetivos: Presentación de causa infrecuente de abdomen agudo hemorrágico. Reporte de Caso: Se presenta un caso de una mujer de 36 años primigesta, con embarazo de 27 semanas, con abdomen agudo, sin antecedentes traumáticos y signos de shock hipovolémico. Ecografía abdominal con líquido libre en cavidad. En laparotomíaexploradora se halla laceración de vena uterina derecha, se realiza hemostasia directa y cesárea de urgencia por bradicardia fetal severa. Discusión: Debe realizarse un correcto diagnóstico diferencial dado que el tratamiento de la rotura espontanea de los vasos uterinos es el manejo urgente del shock hipovolémico y la intervención quirúrgica a la brevedad...

Spontaneous rupture of uterine vessels is a rarecause of acute abdomen bleeding during pregnancy and apotentially fatal complication.Clinical manifestations include sudden abdominal pain,hypovolemic shock and fall of hematocrit.Objectives: Introducing rare cause of acute abdomen bleeding.Case Report: We presents case of a woman aged 36 with 27weeks pregnancy (first one), acute abdomen, without traumatichistory WITH signs of hypovolemic shock. Abdominal ultrasoundwith free fluid in the cavity. At laparotomy we found laceration ofthe right uterine vein, performing direct hemostasis andemergency cesarean for severe fetal bradycardia.Discussion: We have to make sure of doing a correct differentialdiagnosis because the treatment of spontaneous rupture of theuterine vessels is urgent for management of hypovolemic shockand surgery should be performed promptly...

Indicações de cesariana baseadas em evidências: parte II: [revisão] / Evidence-based cesarean section indications: part II: [review]

A alta incidência de cesarianas desnecessárias é motivo de preocupação mundial. Estudos demonstraram que os benefícios conferidos ao feto pela cesariana são pequenos. Além de o procedimento se associar a maiores taxas de mortalidade materna, aproximadamente quatro a cinco vezes maiores que o parto vaginal, está também associado ao aumento da morbidade e mortalidade perinatal. Assim, a decisão para realização de uma cesariana deve ser criteriosa e discutida com a paciente. Realizou-se uma revisão da literatura em busca das melhores evidências disponíveis sobre indicações de cesariana. Foram abordadas algumas indicações, como placenta prévia, descolamento prematuro de placenta, vasa prévia, placenta acreta, infecção por HIV, herpes genital, hepatites e por HPV, condiloma genital, gestação múltipla, prolapso do cordão umbilical, distensão segmentar e ruptura uterina. Observou-se que a cesariana está formalmente indicada em algumas situações particulares, como na placenta prévia total. Em outros casos, pode haver indicação de cesárea intraparto, porém situações como HPV e gemelaridade não representam per se indicações de cesárea. Quando essas são relativas, tanto a mulher como seus familiares devem ser informados, e sua opinião deve ser considerada antes de se decidir pela realização da cesárea.

The increasing rate of unnecessary cesareans is a world preoccupation. Studies demonstrated that fetal benefits by cesarean are small, and the procedure is associated with higher rates of maternal death, 4-5-fold greater in relation with vaginal delivery, and increased perinatal morbidity and mortality. Indeed, the decision for a cesarean delivery should be rigorous and discussed with the patient. A literature review was performed searching the best current evidences evaluable. Indications for cesarean section were analyzed such as placenta praevia, abruptio placentae, vasa praevia, accretism, HIV infection, genital herpes, hepatitis, HPV and condiloma, multiple pregnancy, umbilical cord prolapse, distension and rupture uterine. In special circumstances like total placenta praevia an elective cesarean section is indicated. In other cases, an intrapartum cesarean section should be performed but situations like HPV and multiple pregnancy are not considered indications for cesarean per se. When relative indications for cesarean are present, both women and her family should be informed and their opinion considered when deciding for an operative delivery.

Comportamiento clínico epidemiológico de abdomen agudo quirúrgico durante el embarazo / Epidemiological clinic behaviour of surgical acute abdomen during the pregnancy

Se realiza un estudio descriptivo y transversal para determinar el comportamiento clínico epidemiológico del abdomen agudo quirúrgico en las gestantes atendidas en la clínica el fateh suka, burkina faso, áfrica, en el período comprendido de agosto 2003 a julio 2006. La muestra de estudio estuvo conformada por 115 gestantes que presentan abdomen agudo quirúrgico diagnosticado en la clínica. El abdomen agudo quirúrgico se presenta con más frecuencia en las edades comprendidas de 20 a 24 años, siendo más frecuente en el segundo trimestre del embarazo. El síndrome hemorrágico fue el de mayor incidencia debido a embarazo ectópico y rotura uterina. El aborto fue la complicación que predominó y hubo 26 gestantes fallecidas (AU)

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.

Rotura uterina tras parto vaginal con distocia de hombros / Uterine rupture after vaginal delivery with shoulder dystocia

Objetivo. Describir el caso clínico de una rotura uterina tras parto vaginal en el contexto de una distocia de hombros, interesante por la baja incidencia de presentación y por la gravedad que conlleva. Sujetos y métodos. Se analizan los factores de riesgo de la rotura uterina y la sintomatología típica del cuadro. Resultado. Exposición del diagnóstico diferencial ante una mala evolución posparto, pruebas complementarias a realizar y conducta a seguir. Conclusiones. Es de destacar la importancia de incluir la rotura uterina en el diagnóstico diferencial tras un parto distócico. El diagnóstico precoz es importante, ya que la rotura uterina es una emergencia vital para la gestante, y una de las causas más relevantes de mortalidad materna(AU)

Objective. To describe a case uterine rupture after vaginal delivery associated with shoulder dystocia. This case is of interest due to the seriousness and low incidence of this event. Subjects and methods. Risk factors for uterine rupture and its typical symptoms were analyzed. Result. We present the differential diagnosis to be performed when postpartum course is poor, as well as the complementary tests and the procedure to be carried out. Conclusions. We emphasize the importance of including uterine rupture in the differential diagnosis after a dystocic delivery. Early diagnosis is essential since uterine rupture is a potentially catastrophic event and is one of the most important causes of maternal mortality(AU)

Rotura espontánea de útero bicorne en gestación asociada a acretismo placentario / Spontaneous uterine rupture in a bicornuate uterus associated with placenta accreta

La rotura espontánea en útero bicorne gestante es un accidente poco frecuente y difícil de diagnosticar. La prevalencia de malformaciones uterinas congénitas entre las mujeres fértiles está documentada entre 1-2 por ciento de la población; de éstas, el útero bicorne varía entre un 25 a 37 por ciento. Generalmente la rotura de la pared uterina sucede en el segundo trimestre, presentándose como intenso dolor abdominal a consecuencia de la hemorragia intraperitoneal. Presentamos caso clínico de una paciente gestante de 19 semanas con útero bicorne en el que se produjo una rotura uterina asociada a acretismo placentario. La placenta acreta y el útero bicorne son 2 entidades muy poco frecuentes pero que pueden asociarse. Como tratamiento se realizó una hemihisterectomía izquierda con una evolución satisfactoria.

The sudden rupture in bicornuate pregnant uterus is an uncommon and difficult-to-diagnose occurrence. The prevalence of congenital uterine malformations amongst fertile women is documented for 1-2 percent of the population; of these, bicornuate uterus varies from 25 to 37 percent. The rupture of the uterine wall happens generally in the second trimester, accompanied by an intense abdominal pain as a result of the intraperitoneal hemorrhage. We report a case of a 19 weeks pregnancy with an uterine rupture in a bicornuate uterus associated with a placental accretism. Both placental accretism and bicornuate uterus are uncommon but can be related. A left-side hemihysterectomy was applied leading to a satisfactory evolution.