Spontaneous rupture of unscarred uterus in early pregnancy: - a rare entity

Singh, Abha; Jain, Sandhi

doi:10.1080/j.1600-0412.2000.079005431.x

Cited by 20 publications

(14 citation statements)

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“…The site of rupture reported by Singh et al . (7) was similar to ours but contrasted significantly in presentation. In retrospect, the time of rupture was probably much earlier in pregnancy, and subsequently as the hole got bigger the second twin and its membranes and placenta became extruded into the peritoneal cavity.…”

Section: Discussionsupporting

confidence: 87%

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Fundal hiatus discovered in a presumably unscarred uterus at emergency cesarean: an old perforation or rupture?

Sobande

Al-Sunaidi

Al-Ghamdi

et al. 2002

Acta Obstet Gynecol Scand

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Rupture of the uterus is a disastrous event for both the mother and fetus, and can be classified into three groups according to its etiology: rupture of a previous cesarean section scar, iatrogenic or traumatic rupture of the intact uterus, and spontaneous rupture of the intact uterus. The last scenario can further be subdivided into (a) those associated with uterine anomaly, placenta percreta, pyometra, hydatidiform mole, grand multiparity or pathological growth and (b) that occurring in a primiparous patient with a sound, intact and normal uterus. The latter is a very rare entity.We present a case of an unexpected fundal hiatus discovered in a presumably unscarred uterus at emergency cesarean section in a twin pregnancy without labor. The appearance of the fibrotic edge of the defect strongly suggested a chronic event (rupture or previous perforation) with the expulsion of the second twin through the defect at a much later date. The two fetuses died in utero, but in retrospect one of the fetuses might have been salvaged or even both if a suspected uterine perforation at previous evacuation was dealt with adequately. Case reportA 32-year-old apparently healthy Saudi women, gravida 11, para 6, who had had four previous miscarriages presented to the emergency room (ER) at 31 weeks gestation with a 2-h history of mild lower abdominal pain and back ache. There was no associated vaginal bleeding nor were there urinary symptoms. She had been feeling fetal movements satisfactorily before admission. She had had uncomplicated full-term pregnancies, normal vaginal deliveries and four miscarriages. The birth weight ranged between 25000 and 3000 g, while the post partum periods were uneventful. She also had uneventful evacuation of the uterus following each miscarriage; the last miscarriage was a blighted ovum at 8 weeks followed by uncomplicated suction evacuation of the uterus. This event occurred approximately 6 months before the index pregnancy. There was no history of C Acta Obstet Gynecol Scand 81 (2002) twins in the family. No other relevant family history was obtained. Her periods were regular and this pregnancy was spontaneous.She booked for antenatal care at our hospital at 17 weeks gestation when the pregnancy was diagnosed as twins during routine ultrasound (dichorionic placenta), and other routine booking investigations were requested and were normal. She was admitted at 26 weeks because of painless vaginal bleeding and was diagnosed as having placenta praevia. She discharged herself against medical advice 4 days later only to attend the antenatal clinic at 29 weeks gestation. She was given the option of admission and refused, but returned to ER 2 weeks later with abdominal painsOn examination her general condition was satisfactory with a pulse rate of 96 beats/min and a blood pressure of 110/70 mmHg. She was mildly pale but not jaundiced.Chest and cardiovascular systems were unremarkable. Abdominal examination revealed a 34-week sized uterus, which was neither tense nor tender. The pregnancy was twin with c...

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Section: Discussionsupporting

confidence: 87%

“…With increasing use of misoprostol as an agent for induction of labor, more cases of rupture of unscarred uterus have been reported (6). Spontaneous rupture of an unscarred uterus has occurred in the first and last trimesters of pregnancy (7–8).…”

Section: Discussionmentioning

confidence: 99%

Fundal hiatus discovered in a presumably unscarred uterus at emergency cesarean: an old perforation or rupture?

Sobande

Al-Sunaidi

Al-Ghamdi

et al. 2002

Acta Obstet Gynecol Scand

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“…First-trimester uterine rupture is very rare and poses a diagnostic dilemma. Few cases have been reported in the literature 1–3. We are reporting the earliest GA encountered at the time of spontaneous rupture according to our review of available literature.…”

Section: Discussionmentioning

confidence: 97%

Spontaneous rupture of an unscarred uterus in early pregnancy: a rare but life-threatening emergency

Amro

Lotfi

2019

BMJ Case Rep

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Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.

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“…Supporting the decision to eliminate the most serious possible cause of the pain are the data suggesting that the incidence of rupture of an unscarred uterus is estimated to be 1/8,000 to 1/15,000 deliveries. 5 The poor condition of the newborn at birth illustrates the morbidity of delay. The length of time of fetal oxygen deprivation is directly related to the baby's respiratory and metabolic status, 6 and the decline in oxygen and buffer base occurs rapidly during acute, severe fetal compromise.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Complete Uterine Rupture in a Nonlaboring, Early Third-trimester Uterus: Missed Diagnosis by Ultrasound

et al. 2013

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Objective Describe potential consequences and remedy for not intermittently auscultating fetal heart tones during travel to the imaging department and misdiagnosing a ruptured uterus on ultrasound as a synechiae.Study Design Retrospective chart review of case.Results Spontaneous uterine rupture in pregnancy is a rare and catastrophic event. Fetal monitoring is an important component for diagnosis, but fetal heart auscultation is usually discontinued while the patient is receiving imaging. We present a ruptured uterus at 28 weeks with delayed diagnosis secondary to interrupted fetal heart tone auscultation and a misdiagnosis of a rupture as a synechiae resulting in a seriously compromised newborn at delivery.Conclusion Intermittent fetal heart tone auscultation is a possible method of monitoring when the patient is off continuous fetal monitoring.

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Spontaneous rupture of unscarred uterus in early pregnancy: - a rare entity

Cited by 20 publications

References 0 publications

Fundal hiatus discovered in a presumably unscarred uterus at emergency cesarean: an old perforation or rupture?

Fundal hiatus discovered in a presumably unscarred uterus at emergency cesarean: an old perforation or rupture?

Spontaneous rupture of an unscarred uterus in early pregnancy: a rare but life-threatening emergency

Spontaneous Complete Uterine Rupture in a Nonlaboring, Early Third-trimester Uterus: Missed Diagnosis by Ultrasound

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