Incidence and contributing factors for uterine rupture in patients undergoing second trimester termination of pregnancy in a large tertiary hospital - a 10-year case series

Choon, Koh Daniel Seow; Chaw, Tan Eek; Qi, Qi Lau Hester Chang; Jack, NG Mor; Shi, Tay Wan; Hian, Tan Kok

doi:10.1016/j.ejogrb.2018.05.016

Cited by 5 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is rare to happen in the rst and second trimesters. Uterine rupture usually acompany with abnormal fetal heart rate, acute blood loss and hemorrhagic shock [1] [2]. But in our case, the rupture happened on the 20th weeks ,the location of uterine rupture was not at common surgical incision, and because of the rupture was covered by the greater omentum, the patient didn't have typical symptom.…”

Section: Introductionmentioning

confidence: 58%

Complete uterine rupture in the second trimester of pregnancy and covered by greater omentum to stop bleeding：a case report

Huang,

Sun

2023

Preprint

View full text Add to dashboard Cite

Background: Uterine rupture usually occurs during delivery, acompany with abnormal fetal heart rate, acute blood loss and hemorrhagic shock. But in our case, the rupture happened on the 20th weeks, the location of uterine rupture was not at common surgical incision, and because of the rupture was covered by the greater omentum, the patient didn’t have severe tearing pain, hypovolemic shock, significant decrease in hemoglobin, vaginal bleeding, and normal fetal heart rate. It was a situation that was easy to miss diagnosis and cause serious maternal complications. Case presentation: A 24-year-old G2C1 pregnant woman was admitted to our hospital due to "20 + 5 weeks of menopause, epigastric and right lower abdominal pain with nausea and vomiting for 6 days". The patient underwent laparoscopic exploration, and During the laparoscopic exploration: the appendix, intestine, spleen, ovary and other abdominal organs were normal, we only found the fundus of the uterus was adherent to the greater omentum, and the remaining uterus was smooth. Only by decisively separating the greater omentum from the position of close adhesion with the uterus can the rupture be seen. After separating, the amniotic sac ruptured naturally, a male stillborn fetus was delivered through the rupture and we suture the rupture. Conclusions: For the first and second trimester of pregnancy, abdominal pain is the only major clinical symptom of uterine rupture, and the pain is non-specific, starting a few hours to a few days before the diagnosis. Uterine rupture usually happens after uterine surgery, placental implantation, improper use of uterine contraction drugs, and obstetric surgical procedures. These suggest that uterine rupture should be considered in the diagnosis of all pregnant women with acute abdomen pain. The greater omentum as a source of resident inflammatory cells and stem cells that can be used to participate in the local control of infection, wound healing, and tissue regeneration. If patients’ symptom is untypical, we should take attention to the greater omentum’s influences.

show abstract

Section: Introductionmentioning

confidence: 58%

Complete uterine rupture in the second trimester of pregnancy and covered by greater omentum to stop bleeding：a case report

Huang,

Sun

2023

Preprint

View full text Add to dashboard Cite

show abstract

“…With the introduction of the two-child policy in China, there have been increases in numbers of women with scarred uterus, who are therefore prone to uterine rupture, postpartum hemorrhage, placenta previa, and placenta accreta (PA) (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Development of a Novel Nomogram for Predicting Placenta Accreta in Patients With Scarred Uterus: A Retrospective Cohort Study

Yang

Qiao

et al. 2019

Front. Med.

View full text Add to dashboard Cite

The aim of this study was to develop a nomogram to predict the risk of placenta accreta in scarred uterus patients in China. Methods: We retrospectively analyzed 8,371 singleton pregnancies with scarred uterus at Shengjing Hospital, affiliated with China Medical University. Two thirds of the patients were randomly assigned to the training set (n = 5,581), and one third were assigned to the validation set (n = 2,790). Multivariate logistic regression was performed by using the training set, and the nomogram was developed. Discrimination and calibration were performed by using both the training and validation sets. Results: The multivariate logistic regression model identified number of previous cesarean section, number of vaginal bleeding, medication during pregnancy, and placenta previa as covariates associated with placenta accreta. A nomogram was developed to predict the risk of placenta accreta in the training set with a Harrell's C-index of 0.93 and 0.927 in the training set and validation set, respectively. Calibration of the nomogram predicted placenta accreta corresponding closely with the actual placenta accreta. Conclusion: We developed a nomogram predicting the risk of placenta accreta in scarred uterus patients in China. Validation using both the training set and the validation set demonstrated good discrimination and calibration, suggesting good clinical utility.

show abstract

“…Two patients had severe bleeding that required blood transfusion and one hysterectomy was necessary. Recently, in a study of 339 patients with a scarred uterus, Daniel et al reported 7 uterine rupture (2.1%) but they limited their study under 23 weeks of gestation (26). Uterine rupture is the most serious complication of labour induction and a history of previous CD is an important contributing factor (26).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, in a study of 339 patients with a scarred uterus, Daniel et al reported 7 uterine rupture (2.1%) but they limited their study under 23 weeks of gestation (26). Uterine rupture is the most serious complication of labour induction and a history of previous CD is an important contributing factor (26). The reported incidence ranges from 0% to 0.5% in patients with a scar-free uterus (26).…”

Section: Discussionmentioning

confidence: 99%

“…Uterine rupture is the most serious complication of labour induction and a history of previous CD is an important contributing factor (26). The reported incidence ranges from 0% to 0.5% in patients with a scar-free uterus (26). Daskalalis et al reported a case of uterine rupture in a patient with no history of CD or uterine surgery after using misoprostol, leading to think there might be other factors that may increase the risk of uterine rupture among patients undergoing labour induction for TOP or IUFD (2).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of induction of labour in case of pregnancy termination or intrauterine fetal death in patients with a scarred uterus: a retrospective cohort study

et al.

View full text Add to dashboard Cite

Objective: Assess efficacy and safety of labour induction in women with one or more previous caesarean deliveries during second and third trimester pregnancy termination or intrauterine fetal death. Design: Retrospective single-centre study between 2007 and 2018. Setting: Lille, France Population: 136 women with history of previous caesarean deliveries (CD) (study group) and 272 controls undergoing labour induction for pregnancy termination or intrauterine fetal death. Methods: Before 32 weeks, misoprostol 400 μg was given orally every 3 hours up to a maximum of five doses in 24 hours. Study group received half doses. After 32 weeks, oxytocin infusion, misoprostol (PGE1) or PGE2 (dinoprostone) were used according to the Bishop score. Main outcome measures: Vaginal delivery within the 24 hours after induction without uterine rupture or severe post-partum haemorrhage defined as blood loss > 1 litre (PPH). Results: Vaginal delivery within the 24 hours after induction without uterine rupture or PPH was 83.5% in the study group versus 92.6% in the control group (p=0.005). 5 (3.7%) uterine ruptures occurred in the study group, 1.7% in case of one previous CD and 15.8% in case of 2 or more previous CD. There were more severe PPH in the study group (6.7% versus 2.2% p=0.03), but no difference was found between women with one or more previous CD. Conclusions: Women with 2 or more prior CD should be informed that they are at higher risk of complications such as uterine rupture and severe post-partum haemorrhage.

show abstract

Incidence and contributing factors for uterine rupture in patients undergoing second trimester termination of pregnancy in a large tertiary hospital - a 10-year case series

Cited by 5 publications

References 29 publications

Complete uterine rupture in the second trimester of pregnancy and covered by greater omentum to stop bleeding：a case report

Complete uterine rupture in the second trimester of pregnancy and covered by greater omentum to stop bleeding：a case report

Development of a Novel Nomogram for Predicting Placenta Accreta in Patients With Scarred Uterus: A Retrospective Cohort Study

Efficacy and safety of induction of labour in case of pregnancy termination or intrauterine fetal death in patients with a scarred uterus: a retrospective cohort study

Contact Info

Product

Resources

About