Rotura uterina asociada a desprendimiento prematuro de placenta normalmente inserta en gestante de 25 semanas / Uterine rupture associated with premature separation of a normally inserted placenta at 25 weeks’ gestation

Se presenta un caso de rotura uterina en paciente secundípara de 25 semanas que ingresó en nuestro centro por rotura prematura de membranas. Se practicó una cesárea de urgencia ante la sospecha de desprendimiento prematuro de placenta normalmente inserta y se objetivó rotura de la cicatriz de la cesárea anterior (AU)

We report a case of uterine rupture in a secundipara at 25 weeks’ gestation who was admitted to our center for premature rupture of membranes. Emergency cesarean section was performed due to suspicion of premature separation of a normally inserted placenta. Rupture of a previous cesarean section scar was observed (AU)

[Emergency embolization in gynaecological bleeding. Two case reports]. / Place de l'embolisation pelvienne en urgence dans les hémorragies d'origine gynécologique. A propos de deux cas.

Two patients with gynaecological hemorrhage underwent successfully trans-arterial embolization. The first womanhad an uncontrollable perineal hemorrhage following a delivery with forceps. Angiography showed extravasation of contrast from right and left vaginal artery. Hyperselective embolisation stopped the vaginal bleeding. The second woman had massive hemorrhage following radiotherapy for cervical cancer. Angiography demonstrated extravasation of contrast from both uterine arteries. The bleeding was controlled after hyperselective embolisation. Emergency arterial embolisation is a safe and effective means of control of irrepressible genital hemorrhage.

Trends in uterine rupture in Enugu, Nigeria.

Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to determine any change in pattern of presentation, management and outcome of such patients. The birth register of 4,333 deliveries at the University of Nigeria Teaching Hospital Enugu from January 1997 and December 2000 were reviewed. Forty-one cases of ruptured uterus were identified and analysed. The incidence of uterine rupture was 1 in 106 deliveries with a mean maternal age of 31.2 years. The majority (75.6%) of the patients were multiparous and had some form of antenatal care (61%) with 19.5% of the total booked at the Teaching Hospital. Many (78.1%) of the patients were in labour for 24?hours or less and 22.0% had oxytocin to augment or induce labour. The majority (68.3%) had a previously scarred uterus and many (53.6%) had lower segment ruptures. At laparotomy 31.7% had repair alone, 29.2% had repair with tubal ligation, 22.0% subtotal hysterectomy and 17.1% total hysterectomy. Perinatal mortality was high (87.8%) and maternal mortality rate 48.8 per 1,000 deliveries. Labour in a previously scarred uterus was the most common aetiological factor followed by obstructed labour in a multiparous woman. The incidence of ruptured uterus is still rising at Enugu, Nigeria but maternal mortality, due to uterine rupture continues to fall. The most commonly performed surgery is repair with or without sterilisation rather than hysterectomy.

Rotura uterina en gestación a término tras metroplastia histeroscópica / Uterine rupture in a term pregnancy after hysteroscopic metroplasty

Describimos el caso de una primigesta de 32 años, con antecedentes de esterilidad primaria y resección de tabique uterino vía histeroscópica en la que se produjo perforación fúndica con el resectoscopio, que se inició con rotura uterina en gestación a término conseguida mediante inseminación artitificial de cónyuge (IAC) y con resultado final de muerte fetal

We describe the case of a 32 years old primiparous patient with the antecedents of infertility and resection of an uterine septum through histeroscopy, in which a perforation of the fundus occured and showed later as an uterine rupture at the 37th week of pregnancy, that was achieved with an artificial insemination and resulted in a fatal outcome

Vesicouterine fistulas: imaging findings in three cases.

OBJECTIVE: The objective of our report is to present three cases of vesicouterine fistulas secondary to a cesarean delivery, a uterine rupture during labor, and radiation therapy. The delay between the onset of symptoms and the diagnosis varied between 3 and 7 years. Different techniques such as color Doppler sonography, excretory urography, cystography, CT, MRI, cystoscopy, vaginoscopy, and hysterography were performed with variable results, mostly negative and sometimes undefined. CONCLUSION: The definitive diagnosis was made with contrast-enhanced helical CT after cystography in one case, unenhanced helical CT after hysterography in another case, and cystography in the third case. Vesicouterine fistula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and endoscopic tests. The diagnosis is made on imaging after opacification of the uterus or the bladder depending on the pressure gradient obtained and the location of the fistula in relation to the uterine isthmus.

Conservative management of vesicouterine fistula after uterine rupture.

We report the closure of a vesicouterine fistula with conservative management utilizing an indwelling transurethral Foley catheter. Uterine rupture occurred during a trial of vaginal birth after cesarean section, necessitating an emergency cesarean section. Upon entry into the abdomen, the base of the bladder was noted to be involved in the uterine rupture. The bladder trigone and ureteral orifices appeared normal. A primary, two-layer bladder repair was performed. A cystogram on postoperative day 14 demonstrated a vesicouterine fistula. Conservative management involving bladder drainage for 21 days with a transurethral Foley catheter was successful in closure of the fistula. Vesicouterine fistula, a documented complication of uterine rupture due to attempted vaginal birth after previous cesarean section, can spontaneously resolve with conservative management alone.

[Massive pulmonary embolism during pregnancy treated with streptokinase and complicated by massive haemorrhage--a case report]. / Masywny zator tetnicy plucnej u mlodej kobiety w pierwszym trymestrze ciazy. Skuteczne leczenie streptokinaza. Powiklanie masywnym krwawieniem z dróg rodnych.

A case of a 27-year-old pregnant female (first trimester) is described. The patient was hospitalised due to pregnancy complications and immobilised for 3 weeks. At the end of this period patient's clinical condition rapidly deteriorated and she developed shock, followed by cardiac arrest. Echocardiography was consistent with acute pulmonary embolism and the patient received streptokinase. This treatment was complicated by a massive bleeding due to the rupture of the uterus. She underwent hysterectomy and recovered thereafter.

Changes in fetal heart rate and uterine patterns associated with uterine rupture.

OBJECTIVE: To determine changes in fetal heart rate (FHR) and uterine patterns preceding complete uterine rupture. STUDY DESIGN: FHR and uterine patterns of 50 women with uterine rupture were compared with 601 tracings of controls without scarred uteri. Tracings were interpreted using the National Institute of Child Health and Human Development Research Planning Workshop guidelines. RESULTS: Interobserver and intraobserver agreements of FHR and uterine tracings in the uterine rupture group were excellent (kappa of .96 for both variables). Comparing tracing patterns during the first stage, higher rates of severe fetal bradycardia (4.0% vs. 1.0%, P = .064), fetal tachycardia (8.0% vs. 2.3%, P = .042), reduced baseline variability (24.0% vs. 12.5%, P = .021), uterine tachysystole (10.0% vs. 0.8%, P < .001) and disappearance of contractions (6.0% vs. 0, P < .001) were noted among patients with uterine rupture as compared to the controls. During the second stage of labor, patients with uterine rupture had significantly higher rates of reduced baseline variability (47.8% vs. 7.7%, P < .001), severe variable decelerations (26.1% vs. 6.4%, P = .004), uterine tachysystole (22.0% vs. 0.5%, P < .001) and disappearance of contractions (13.0% vs. 0, P < .001). Using a backward, stepwise multiple logistic regression model, severe fetal bradycardia (OR = 8.2, 95% CI 2.2-31.0, P = .002) and uterine tachysystole (OR = should alert the 8.0, 95% CI 1.7-37.9, P = .008) were found to be independent patterns preceding uterine rupture during the first stage of labor. Likewise, during the second stage, reduced baseline variability (OR = 4.2, 95% CI 1.4-12.3, P = .009) and uterine tachysystole (OR = 42.3, 95% CI 10.6-168.3, P < .001) were independently associated with uterine rupture in another multivariable analysis. CONCLUSION: Abnormal monitor patterns among women presenting with risk factors for uterine rupture, specifically uterine tachysystole, reduced baseline variability and severe bradycardia, should act as warning signs to the obstetrician.

Conservative management of spontaneous uterine perforation associated with placenta accreta: a case report.

BACKGROUND: Placenta accreta occurring in an unscarred uterus is exceedingly rare. Previous cases of spontaneous uterine perforation associated with placenta accreta were treated with hysterectomy. CASE: A nulliparous woman was clinically diagnosed with placenta accreta when spontaneous vaginal delivery was complicated by postpartum hemorrhage and a retained placenta. Magnetic resonance imaging subsequently revealed focal areas of placenta accreta. Acute-onset abdominal pain and cul-de-sac fluid prompted diagnostic laparoscopy, which revealed a spontaneous uterine perforation in the right posterior-lateral aspect of the uterus. This area was oversewn, and the patient received 2 weeks of postoperative antibiotics because of Enterococcus faecalis bacteremia. CONCLUSION: Spontaneous uterine perforation associated with placenta accreta can be managed conservatively.

Twin-to-twin transfusion syndrome complicated by spontaneous mid-trimester uterine rupture.

Twin-to-twin-transfusion syndrome (TTS) is a serious complication in about 15% of monochorionic twin pregnancies. In severe TTS, the anemic pump twin (donor) develops anhydramnios and the hypervolemic recipient tense polyhydramnios, which often first calls attention to the condition. The most common problems of TTS are fetal complications such as single or double intrauterine demise, spontaneous abortion, prematurity due to uterine distension leading to contractions, preterm rupture of membranes and ultimately neurological impairment. We report a pregnancy with TTS in which rapid development of polyhydramnios led to rupture of a scarred uterus at 19 weeks' gestation. To the best of our knowledge, this is the first report of a potentially lethal maternal complication of TTS.

Ruptured uterus in South Western Nigeria: a reappraisal.

INTRODUCTION: Rupture of the gravid uterus is a grave obstetric complication that is associated with high maternal and perinatal mortality rates. In Nigeria, the incidence remains high and continue to increase because of poverty, illiteracy, unavailability of manpower, poor supply of medical equipment and consumables, and dwindling health care funding. METHODS: A 10-year retrospective review of all cases of ruptured uterus seen at the Obafemi Awolowo University teaching hospital complex in Ile Ife, Nigeria was conducted. RESULTS: A total of 61 cases of ruptured uterus from 16,683 deliveries were recorded, giving a ratio of 1 in 273. Predisposing or aetiological factors for rupture were: prolonged labour (91.8 percent), grand multiparity (50.8 percent), injudicious use of oxytocin (41.0 percent), uterine scar (26.2 percent), obstetric manipulation (4.9 percent) and abnormal lie (14.8 percent). Fifty-six patients had surgery, of which 14 (25.0 percent) had total abdominal hysterectomy, 16 (28.6 percent) had subtotal hysterectomy, 15 (26.8 percent) had repair of the rupture and bilateral tubal ligation, and 13 (19.6 percent) had repair only. Thirteen maternal deaths occurred with a case fatality rate of 21.3 percent. CONCLUSION: Ruptured uterus remains a problem in Nigeria, with primary health centres and mission houses being identified as major contributors to this condition. They primarily failed in the recognition of abnormalities in the antepartum and/or intrapartum periods, with delays in referral and the injudicious use of oxytocin.

Uterine rupture: risk factors and pregnancy outcome.

OBJECTIVES: This study aimed at determining risk factors and pregnancy outcome in women with uterine rupture. STUDY DESIGN: We conducted a population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 1999. RESULTS: Uterus rupture occurred in 0.035% (n=42) of all deliveries included in the study (n=117,685). Independent risk factors for uterine rupture in a multivariable analysis were as follows: previous cesarean section (odds ratio [OR]=6.0, 95% CI 3.2-11.4), malpresentation (OR=5.4, 95% CI 2.7-10.5), and dystocia during the second stage of labor (OR=13.7, 95% CI 6.4-29.3). Women with uterine rupture had more episodes of postpartum hemorrhage (50.0% vs 0.4%, P<.01), received more packed cell transfusions (54.8% vs 1.5%, P<.01), and required more hysterectomies (26.2% vs 0.04%, P<.01). Newborn infants delivered after uterine rupture were more frequently graded Apgar scores lower than 5 at 5 minutes and had higher rates of perinatal mortality when compared with those without rupture (10.3% vs 0.3%, P<.01; 19.0% vs 1.4%, P<.01, respectively). CONCLUSION: Uterine rupture, associated with previous cesarean section, malpresentation, and second-stage dystocia, is a major risk factor for maternal morbidity and neonatal mortality. Thus, a repeated cesarean delivery should be considered among parturients with a previous uterine scar, whose labor failed to progress.

Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: A review of the literature.

OBJECTIVE: The purpose of this study was to determine the rate of uterine rupture and its complications as the result of trial of labor after previous cesarean delivery. STUDY DESIGN: PubMed was searched from 1989 to 2001, with the terms "VBAC, uterine rupture," "trial of labor, uterine rupture," "cesarean delivery, uterine rupture," and "scarred uterus, rupture." For inclusion, reports had to contain data from at least 100 patients with trials of labor that included a description of adverse outcomes. Duplicate reporting from a single institution was excluded. Odds ratios and 95% CIs were calculated. RESULTS: Seventy-two of the 361 articles (20%) that were identified met the inclusion criteria. A 6.2 per 1000 trial of labor rate of uterine rupture (total=880 uterine ruptures in 142,075 trials of labor) was determined. For every 1000 trials of labor the uterine rupture-related complication rate was 1.8 for packed red blood cell transfusion, 1.5 for pathologic fetal acidosis (cord pH<7.00), 0.9 for hysterectomy, 0.8 for genitourinary injury, 0.4 for perinatal death, and 0.02 for maternal death. The perinatal mortality rate was significantly lower among studies from the United States versus other countries (0.3 vs 0.6; odds ratio, 0.50; 95% CI, 0.26-0.94) and in series that exceeded 1000 patients (0.2 vs 1.7; odds ratio, 7.34; 95% CI, 3.94-13.69). CONCLUSION: Although relatively uncommon, uterine rupture is associated with several adverse outcomes, depending on the time of the publication and the site and size of the population that was studied.

[Uterine rupture of the unscarred uterus. About 28 cases]. / Rupture utérine sur utérus sain gravide. A propos de 28 cas.

OBJECTIVES: To determine the etiologic factors explaining the appearance of uterine rupture on unscarred gravid uterus and to value the maternal and foetal prognosis of this complication. PATIENTS AND METHODS: The authors report a study of 28 cases of uterine rupture on unscarred gravid uterus, recorded between January 1989 and December 1997, at the department of obstetrics and gynecology, Farhat Hached University Hospital, Sousse, Tunisia. RESULTS: Out of the 72283 deliveries during the study period, there were 28 ruptured uteri of unscarred uterus giving a hospital incidence of one in 2581 deliveries. Multiparity, neglected labour dystocia and obstetric procedure were the common etiologic factors accused in the occurring of this complication. To be added to these factors: the low socio-economic status of the patients and lack of antenatal care. The surgical management was conservative (repair) in 19 cases (67.9%); hysterectomy was indicated in nine cases (32.1%). Maternal and fetal morbidity and mortality were important: we deplore two maternal deaths (7.1%) and seven fetal deaths (24.1%). DISCUSSION AND CONCLUSION: Uterine rupture on unscarred uterus is a relatively rare complication of the pregnancy. However, its incidence remains high in developing countries. Its occurrence is significantly associated with grandmultiparity, lack of antenatal care and low socio-economic status of the patients.