Spontaneous Uterine Rupture Secondary to Morbidly Adherent Placenta in an Unscarred Uterus

Sajjad, Nida; Khandwala, Kumail; Memon, Wasim; Shahid, Jehanzeb; Zafar, Burhan

doi:10.7759/cureus.7281

Cited by 2 publications

(4 citation statements)

References 8 publications

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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%

“…Nine women (10.7%) had a morbidly adherent placenta, mainly a placenta percreta, 13,15,74–77,93,94,97 and 2 (2.4%) had adenomyosis 96,98 . A uterine anomaly was present in 8 ruptures (9.5%): 3 bicornuate uteri, 9,72,73 2 didelphys, 70,97 1 arcuate with right tubal occlusion, 26 and 2 unicornuate with noncommunicating rudimentary horns 32,71 …”

Section: Resultsmentioning

confidence: 99%

“…91,[94][95][96] Labor-related complications contributed to 4 ruptures; in 3 women (3.6%), 36,84,88 the labor was prolonged, and in the fourth, the labor was obstructed. 30 Nine women (10.7%) had a morbidly adherent placenta, mainly a placenta percreta, 13,15,[74][75][76][77]93,94,97 and 2 (2.4%) had adenomyosis. 96,98 A uterine anomaly was present in 8 ruptures (9.5%): 3 bicornuate uteri, 9,72,73 2 didelphys, 70,97 1 arcuate with right tubal occlusion, 26 and 2 unicornuate with noncommunicating rudimentary horns.…”

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: Resultsmentioning

confidence: 99%

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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“…Uterus scarring after previous a CS (especially in women who did not give birth by natural pathways) and induction of labour using prostaglandins are the most important risk factors for uterine rupture. According to the literature, the likelihood of uterine rupture is also increased by the short period (<12 or <24 months) after previous CS, augmentation of labour using oxytocin, abnormal fetal position, an excessive amount of amniotic fluid, abnormally invasive placenta (especially placenta increta and placenta percreta), placental abruption, connective tissue diseases, adenomyosis, trauma, uterine abnormalities [1,3,4,7,8] and even decreased myometrial scar thickness on ultrasound (less than 2.8 mm) [9]. However, there are other large-sample studies which indicate that births by natural pathways increase the risk of symptomatic uterine scar rupture after one CS by only 0.27%.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Uterine Rupture: A Fifteen Year Review

Savukynė

Bykovaite-Stankeviciene

Machtejevienė

et al. 2020

Medicina

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Background and objectives: To assess the incidence of complete and partial uterine rupture during childbirth in a single tertiary referral centre as well as the significant risk factors, symptoms and peripartum complications. Materials and Methods: A retrospective single-centre study involved all cases of uterine rupture at the Kaunas Perinatal Centre in 2004–2019. Data were from a local medical database complemented with written information from medical records. We included 45,893 women with an intact uterus and 5630 with uterine scars. Women (n = 5626) with scarred uterus’ after previous cesarean delivery. The diagnosis was defined by clinical symptoms, leading to an emergency cesarean delivery, when complete or partial uterine rupture (n = 35) was confirmed. Asymptomatic cases, when uterine rupture was found at elective cesarean section (n = 3), were excluded. The control group is represented by all births delivered in our department during the study period (n = 51,525). The outcome was complete (tearing of all uterine wall layers, including serosa and membranes) and partial uterine rupture (uterine muscle defect but intact serosa), common uterine rupture symptoms. Risk factors were parameters related to pregnancy and labour. Results: 51,525 deliveries occurred in Kaunas Perinatal Centre during the 15 years of the study period. A total number of 35 (0.06%) symptomatic uterine ruptures were recorded: 22 complete and 13 partial, leading to an incidence rate of 6.8 per 10,000 deliveries. The uterine rupture incidence rate after a single previous cesarean delivery is 44.4 per 10,000 births. 29 (83%) cases had a uterine scar after previous cesarean, 4 (11%) had a previous laparoscopic myomectomy, 2 (6%) had an unscarred uterus. The most significant risk factors of uterine rupture include uterine scarring and augmentation or epidural anaesthesia in patients with a uterine scar after cesarean delivery. The most common clinical sign was acute abdominal pain in labour 18 (51%). No maternal, six intrapartum perinatal deaths (17%) occurred, and one hysterectomy (2.8%) was performed due to uterine rupture. Neonatal mortality reached 22% among the complete ruptures. Average blood loss was 1415 mL, 4 (11%) patients required blood transfusion. Conclusions: The incidence rate of uterine rupture (complete and incomplete) at Kaunas Perinatal Centre is 6.8 per 10,000 deliveries. In cases with a scar of the uterus after a single cesarean, the incidence of uterine rupture is higher, exceeding 44 cases per 10,000 births. The most significant risk factors were uterine scar and augmentation or epidural anaesthesia in a previous cesarean delivery. Acute abdominal pain in labour is the most frequent symptom for uterine rupture.

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Spontaneous Uterine Rupture Secondary to Morbidly Adherent Placenta in an Unscarred Uterus

Cited by 2 publications

References 8 publications

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

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

Symptomatic Uterine Rupture: A Fifteen Year Review

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