DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175873

Mid-trimester rupture uterus: case series

Aishwarya Kapur, Sudha Prasad, Sangeeta Gupta

Abstract


Uterine rupture is an obstetric catastrophe with significant maternal and fetal morbidity and mortality which occurs mainly in the third trimester of pregnancy or during labour, especially in previously scarred uterus. The occurrence of rupture in first and second trimester in women with unscarred uteri is quite rare. We report two cases of rupture uteri managed in our centre at 24 and 26 weeks gestation in women with unscarred uteri. First case was G3P1L1A1, 24 weeks with epigastric pain, stable vitals, epigastric tenderness, USG inconclusive, CT scan showed out pouching of amniotic sac through fundus. Laparotomy done, there was 8-9 cm fundal rupture extending between cornua, uterine repair done. Second case was G3P1L1A1 26 weeks with abdominal pain, stable vitals, corresponding fundal height, head engaged, USG revealed outpouching amniotic sac at the fundus. Laparotomy performed, there was 10 cm rent extending trans-fundal, uterine repair done. Unscarred uterine rupture, especially in early pregnancy is a rare event, posing significant difficulty in diagnosis. Uterine rupture should be first ruled out in all pregnant women presenting with acute abdomen irrespective of gestational age. Search for non-gynaecological causes can delay crucial obstetric intervention that can lead to loss of obstetric function, morbidity and mortality.


Keywords


Midtrimester rupture uterus, Non-gynaecological complaints in rupture uterus, Rupture uterus in early pregnancy, Unscarred uterine rupture

Full Text:

PDF

References


WHO. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health Sci Rep. 2017;7:44093.

Sinha M, Gupta R, Gupta P, Rani R, Kaur R, Singh R. Uterine rupture: a seven-year review at a tertiary care hospital in New Delhi, India. Indian J Community Med. 2016;41(1):45-9.

Baskett TF, Calder AA, Arulkumaran S. Uterine rupture. Munro Kerr’s Operative Obstetrics. 11th ed. Elsevier; 2007:175-80.

Pappalardo EM, Greca ML, Rapisarda G, Consoli D. Uterine rupture after prostaglandin analogues to induce midtrimester abortion. J Prenat Med. 2010;4(1):9-11

Abdulwahab DF, Ismail H, Nusee Z. Second-trimester uterine rupture: lessons learnt. Malays J Med Sci. 2014;21(4):61-5.

Jang DG, Lee GSR, Yoon JH, Lee SJ. Placenta percreta-induced uterine rupture diagnosed by laparoscopy in the first trimester. Int J Med Sci. 2011;8(5):424-42.

Hornemann A, Bohlmann MK, Diedrich K, Kavallaris A, Kehl S, Kelling K, et al. Spontaneous uterine rupture at the 21st week of gestation caused by placenta percreta. Arch Gynecol Obstet. 2011;284(4):875-8.

Wozniak S, Kłudka-Sternik M, Czuczwar P, Szkodziak P, Paszkowski M, Paszkowski T. Placenta percreta leading to uterine rupture at 18 weeks of pregnancy with consecutive hysterectomy: a case report. Ginekol Pol. 2013;84(4):318-20.

Haberal TE, Çekmez Y, Ulu İ, Divlek R, Göçmen A. Placenta percreta with concomitant uterine didelphys at 18 weeks of pregnancy: a case report and review of the literature. J Matern Fetal Neonatal Med. 2016;29(21):3445-8.

Martínez-Garza PA, Robles-Landa LP, Roca-Cabrera M, Visag-Castillo VJ, Reyes-Espejel L, García-Vivanco D. Spontaneous uterine rupture: report of two cases. Cir Cir. 2012;80(1):81-5.