Spontaneous rupture of unscarred uterus in a primigravida: Unusual cause of postpartum collapse

Kathpalia, S.K.; Vasudev, Shalini; Sinha, Preema; Sandhu, Namrita

doi:10.1016/j.mjafi.2015.10.008

Cited by 2 publications

(4 citation statements)

References 10 publications

(8 reference statements)

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“…Whereas most of the women with ruptures had at least 1 risk factor, 25% of the women (21/84) did not have any 28,29,37–55 . A single risk factor was found in 47.6% (40/84) of the women 4,9,11,13,21,25,26,32,35,36,56–83 …”

Section: Resultsmentioning

confidence: 99%

“…Whereas most of the women with ruptures had at least 1 risk factor, 25% of the women (21/84) did not have any. 28,29,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] A single risk factor was found in 47.6% (40/84) of the women. 4,9,11,13,21,25,26,32,35,36, The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor (22/84 [26.2%]), 3,4,11,34,36,[56][57][58][59][60][61][62][84][85][86][87][88][89][90] mainly oxytocin a...…”

Section: Etiological and Risk Factorsmentioning

confidence: 99%

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Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Sgayer,

Dabbah,

Farah

et al. 2023

Obstetrical &Amp; Gynecological Survey

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Importance Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes. Objective To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus. Evidence Acquisition PubMed was searched for the phrases “uterine rupture,” “unscarred,” and “spontaneous.” Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included. Results We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries. Conclusions and relevance Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy. Target Audience Obstetrician-gynecologists, family medicine physicians. Learning Objectives After completing this activity, the learner will be better able to describe the consequences of spontaneous rupture of the unscarred uterus to the mother and fetus; discuss risk factors for spontaneous rupture of the unscarred uterus and its potential occurrence in nulliparous, antepartum, and the first trimester; and discuss how timely assessment of a pregnant woman presenting with abdominal pain impacts survival of the mother and child.

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Section: Resultsmentioning

confidence: 99%

Section: Etiological and Risk Factorsmentioning

confidence: 99%

Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Sgayer,

Dabbah,

Farah

et al. 2023

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

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“…One could argue that timely diagnosis of uterus rupture is difficult in patients with unscarred uteruses, because clinicians mainly expect ruptures in scarred tissue. Severe maternal and neonatal morbidity and mortality are more often observed in women that do not have a history of uterine scarring [ 5 , 11 , 21 , 22 ], including history of curettage [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the unexpectedness of the diagnosis, a delay in treatment has been described [ 22 – 25 ]. A study comparing diagnosis intrapartum and delayed postpartum diagnosis identified independent risk factors for delayed diagnosis of uterus rupture to be an unscarred uterus, epidural analgesia during labor, and grand multiparity [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Term Delivery Complicated by Uterine Rupture with No Prior History of Cesarean Section or Uterine Curettage Following Oxytocin Use and Arrest in Second Stage of Labor: A Case Report

Lindblad,

Moustgaard Jeppesen,

Khalil

2023

Am J Case Rep

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Patient: Female, 34-year-old Final Diagnosis: Uterine rupture Symptoms: Contractions • spontaneous rupture of membranes Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Rare disease Background: Uterine rupture during delivery in an unscarred uterus may be associated with oxytocin dose during second stage arrest and with underlying maternal factors. This report is of a 34-year-old woman, gravida 5, para 3, with no previous history of cesarean section (CS), who had a uterine rupture at term delivery following the use of oxytocin for second-stage arrest. Case Report: A 34-year-old Afghani woman, gravida 5, para 3 was admitted at term for delivery. The current pregnancy had been normal and the estimated birth weight was approximately 4000 g. There was no history of steroid treatment or any underlying connective tissue disease, and no history of dilation and curettage. Oxytocin was given as per protocol, starting at 20 ml/h of a dilution of 10 IU/1 L natrium chloride (NaCl). Subsequent labor progress was complicated by arrest of descent in the second stage of labor, necessitating cesarean section delivery. After opening the abdominal wall, a uterine rupture with several large blood clots was discovered, freely floating in the peritoneal space, about 500 ml in volume. The rupture stretched from the left side of the uterine body and down into the thin lower segment. The tissue in this area had diffuse hematoma. Conclusions: Although uterine rupture mostly occurs in women with previous CS, this report has shown that uterine rupture can occur in pregnancy complicated by arrest in the second stage of labor.

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Spontaneous rupture of unscarred uterus in a primigravida: Unusual cause of postpartum collapse

Cited by 2 publications

References 10 publications

Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Term Delivery Complicated by Uterine Rupture with No Prior History of Cesarean Section or Uterine Curettage Following Oxytocin Use and Arrest in Second Stage of Labor: A Case Report

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