Management of uterine rupture: a case report and review of the literature

Abstract

Background Maternal morbidity and mortality has been a major World Health Organization concern over the years, especially in sub-Saharan Africa. This paper reports uterine rupture with severe hypovolemic shock managed at the Douala General Hospital, Cameroon. Early clinical diagnosis is paramount to maternal survival. Case presentation Mrs. MM aged 25 years, G3P2012, of the Bamileke tribe in Cameroon was admitted to our Department in hypovolemic shock BP = 70/40 mmHg, pulse 120 beats per minute, with altered consciousness (Glasgow Coma Scale = 13). She has a history of missed abortion at 19 weeks gestation and an attempt to evacuate the uterus with misoprostol that led to uterine rupture. She underwent a total abdominal hysterectomy and blood transfusion. Her post-operative stay in hospital was uneventful.ConclusionUterine rupture is a complication that can be eliminated under conditions of best obstetric practice. To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. The survival of patients after uterine rupture depends on the time interval between rupture and intervention, and the availability of blood products for transfusion.

Uterine rupture among mothers admitted for obstetrics care and associated factors in referral hospitals of Amhara regional state, institution-based cross-sectional study, Northern Ethiopia, 2013-2017

“…A total of 125 (16.68%, 95% (14.0%, 19.2%) women experienced uterine rupture which is in line with Burkina Faso (18%)[11]. But, by far higher when compared with that from a study done at Debremarkos (9.5%)[1], Debremarkos 2017 2.24%[12], rural Ethiopia (3.7%)[13], Mizan Aman General Hospital (1.6%)[14], Somalia (0.7%)[15], Mali[7], Benin Nigeria (0.58%)[16] and Israel (6.7%)[17]. Differences in delivery services coverage, accessibility of the facilities as well as the availability of skilled personnel and medical supplies as the study setting differs could contribute to variation observed.…”

“…Globally, the incidence of uterine rupture is 0.07%, which is much lower than the magnitude encountering in Africa-1.3%[6]. Uterine rupture is one of the peripartum complications that causes nearly about one out of thirteen maternal death and the remaining survivors encounter immediate and long-term complexities[7]. In Ethiopia, uterine rupture and obstructed labor together account for 29% of the total maternal mortality.…”

Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data

“…Yet these studies are small, frequently focus on one institution and often fail to adjust for potential confounding variables such as parity or previous cesarean delivery when characterizing health system risk factors for UR [ 8 – 11 ]. Published case reports of UR events provide valuable insights, but may not be applicable to the majority of cases that clinicians and health centers encounter [ 13 – 17 ].…”

Rupture of a myomectomy site in the third trimester of pregnancy after myomectomy, septoplasty and cesarean section: A case report

“…The classic signs and symptoms of uterine rupture include fetal distress, decrease in uterine tone, abdominal pain, the presenting station changing, bleeding and shock [ 9 ]. However, signs and symptoms of uterine rupture are usually nonspecific, which may delay diagnosis and treatment.…”

“…Maternal and neonatal outcomes after uterine rupture depend on the time between rupture and operation and sufficient transfusion [ 9 ]. In the present case, the patient was hospitalized with a weak uterine contraction and was given tocolytic agents.…”