Silent Uterine Rupture with the Use of Misoprostol for Second Trimester Termination of Pregnancy : A Case Report

Abstract

Uterine rupture is an uncommon, but a life-threatening, complication following second trimester medical termination of pregnancy (TOP). The reported cases have been in both the scarred and unscarred uterus (Rajesh et al. 2002, Drey et al. 2006, and Dickinson). A 27-year-old with two previous deliveries, no previous caesarean section, no history of induced abortions, and no gynaecological operations. She presented with amenorrhoea, and according to her last normal menstruation, she was 10 weeks and 5 days. Ultrasound was done, and it reported 16 weeks and 5 days. She asked for TOP. According to the clinic's protocol, misoprostol 800 mcg (4 tabs) were given to be used vaginally as a loading dose and another three to be taken orally after that. In the following day when she attended the clinic for follow up, a manual vacuum aspiration (MVA). A manual vacuum aspiration was indicated as an incomplete abortion. During the procedure, a uterine rupture was found in the uterine lower segment. A laparotomy was done and a lineal uterine rupture was found and sutured. The patient had a good postoperative recovery and was discharged from hospital after four days. The clinician dealing with second trimester terminations should be aware of the possibility of having a uterine rupture, especially in patients with a uterine scar in order to make an early diagnosis.

Foley catheter versus intra-vaginal misoprostol for induction of labor in post-term gestations

“…However, some studies have demonstrated that it may result in higher rates of tachysystole, hyperstimulation, meconium passage, uterine rupture and cesarean delivery rate compared to traditional methods [13,14].…”

Uterine Rupture with Misoprostol at 19 Week of Gestation

“…On the other hand, Güleç et al recommended that misoprostol should be used carefully at patients with one or more prior cesarean sections (5). Also, in literature there are many case reports about uterine rupture at patients with prior surgery after using misoprostol (6,7,8) In our study, the patient had prior surgery; a myomectomy and a cesarean section concomitantly and uterine rupture was occurred with low dose misoprostol. In conclusion, misoprostol have to be used carefully at patients with prior uterine surgery.…”

Uterine rupture in pregnancy: two case reports and review of literature

“…They suggested that this uterine rupture resulted from an unrecognized perforation in a previous intrauterine manipulation. Many cases have been reported of uterine rupture in an unscarred uterus during second trimester pregnancy termination with intravaginal misoprostol [23]. Chang et al reported a case of a multiparous who had a previous vaginal birth delivery and who was labor-induced with PGE2 and oxytocin.…”