Posterior Uterine Rupture Causing Fetal Expulsion into the Abdominal Cavity: A Rare Case of Neonatal Survival

Abstract

Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby. Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response.

Posterior uterine rupture – A devil with many faces

“…Rupture of an unscarred uterus occurs rarely with an estimated occurrence of 1 in 17,000-20,000 deliveries. In India, Pagi et al (1995) found that the most common group was spontaneous (63.69%) followed by scar rupture(22%) and traumatic(14.8%).Very similar figures were also given earlier by Dhar (1989) from Srinagar, India [2]. Clinical signs of uterine rupture during pregnancy are nonspecific, and very variable.…”

A rare case of posterior uterine rupture with neonatal survival during trial of vaginal birth after cesarean section

“…4 This is similar to sacculation in which the posterior uterine wall softens allowing the posterior uterine wall to swell like an aneurysm allowing growth of the fetus into the abdomen with increased risk of UR.…”

“…Rupture of the posterior wall of in women attempting VBAC has also been described, although it's extremely rare. 4 Outcomes of uterine rupture (UR) depend on the time between diagnosis of rupture and delivery. They include fetal and maternal complications.…”

Uterine Rupture at 31 Weeks and Its Outcome- A Case Report

“…Rupture of the unscarred uterus varies more hazardless foetomaternal risk compared to scarred uterus. (2) Even though the mode of presentation was similar for patients with or without CS history, instability, deterioration of vital parameters and vaginal bleeding after labour must remind likelihood of UR.…”

“…A complete UR involves the entire uterine wall leading to a direct connection between the peritoneal space and the uterine cavity, whereas a cover of visceral, peritoneum of the broad ligament is left over the uterus in case of an incomplete UR. (2) In women with two or more prior caesareans, the rate of rupture rises as high as 3.9 percent. (7) The underlying factors for UR include a poor referral system, non-attendance to antenatal care, delay in seeking medical care and delay of essential intervention.…”