A rare case of spontaneous posterior wall rupture in an unscarred uterus during labour

Abstract

Uterine rupture is a dreaded catastroph in obstetrics with a high incidence of maternal and fetal morbidity. In developing Country, the overall prevalence widely varies from 1 in 2,000 to 1 in 200 deliveries. Uterine rupture in an unscarred uterus is a rare event and only a finger countable cased have been reported on posterior rupture of uterus in unscarred uterus. We here presenting a case of spontaneous posterior rupture of an unscarred uterus. Our patient was 38 years old grand multipara, a 6th gravida female with 4 parity, 1 abortion last year and 3 live issues. She was 9 months of gestation with previous all normal vaginal deliveries. This time she had a uterine rupture in the lower segment of posterior wall of uterus during labour. The rupture was unrepeatable, so we have to do hysterectomy. This case points out to keep this catastroph in mind in multiparas with unscarred uterus and to be prepared for the same while assisting a normal vaginal delivery.

Spontaneous uterine rupture complicated by bilateral pulmonary emboli: A case report

“…Spontaneous uterine rupture in an unscarred uterus is a rare event that can lead to maternal and fetal morbidity and mortality. The incidence of rupture of unscarred uteri is 0.0175% to 0.005% of pregnancies [ 1 ]. Causes of uterine rupture include trauma, congenital weakness of the myometrium (e.g., Ehlers-Danlos type IV) [ 2 ], acquired weakness secondary to prolonged labor or uterotonic drugs [ 3 , 4 ], or uterine cavity overdistension due to multiple gestation, high parity, or uterine anomalies [ 1 ].…”

Early Labor Posterior Uterine Wall Rupture in a Primigravid Mother with Successful Repair and Live Birth: A Case Report

“…3 Unscarred pregnancy uterine rupture is an uncommon occurrence that is thought to take place in 1/5700 to 1/20,000 pregnancies. 1,4 The anterior lower portion of the uterus is where the majority of ruptures in unscarred uteruses take place; posterior wall ruptures are scarce. Even more atypical is posterior uterine wall rupture, which has only a few instances published in the literature so far.…”

“…uterine rupture in unscarred or intact uteruses. 4,8,11,12 It has been observed that fetal malposition, such as occipitoposterior position and malpresentation with a transverse line, can cause posterior uterine ruptures. 8 Clinical manifestations of uterine rupture may include acute or abnormal maternal abdominal pain, tachycardia, vaginal bleeding with shock, loss of uterine contractility, and sometimes blood-tinged urine.…”

“…8 Clinical manifestations of uterine rupture may include acute or abnormal maternal abdominal pain, tachycardia, vaginal bleeding with shock, loss of uterine contractility, and sometimes blood-tinged urine. 4,5,13 Often, the earliest signs of uterine rupture are prolonged, late, or recurring variable decelerations or fetal bradycardias. 4,14 Because posterior uterine rupture is so uncommon, typical symptoms might not be present.…”

“…4,5,13 Often, the earliest signs of uterine rupture are prolonged, late, or recurring variable decelerations or fetal bradycardias. 4,14 Because posterior uterine rupture is so uncommon, typical symptoms might not be present. 8 In almost every case, the development of hemorrhagic shock in the patient necessitates immediate laparotomy, urgent resuscitation with rapid infusion of crystalloid solutions, and whole-blood transfusion.…”