Ultrasonic diagnosis of asymptomatic rupture of uterine in second trimester of pregnancy after laparoscopic surgery for interstitial pregnancy: a case report

Abstract

Background Uterine rupture is a rare, life-threatening event in obstetrics that may be fatal for the mother and fetus. Therefore, obstetricians need to pay attention to and should consider the antenatal diagnosis of uterine rupture in women having its risk factors. Successful conservative management for asymptomatic uterine rupture due to previous laparoscopic surgery for interstitial pregnancy has already been reported but remains understudied. Case presentation A 39-year-old woman was diagnosed asymptomatic uterine rupture at 22 weeks gestation by a routine second-trimester ultrasound scan. She had a history of laparoscopic salpingectomy with cornual wedge resection for interstitial pregnancy 10 months before this pregnancy. Refusing doctor’s twice advice of terminating the pregnancy, the patient insisted carrying on the pregnancy, and followed up by ultrasound and magnetic resonance imaging. Fetal growth was appropriate, fetal movements were good and the patient had no symptoms, without uterine contraction or amniotic fluid loss throughout follow-up period. Caesarean section was carried out at 34 + 1 weeks with a good maternal and neonatal outcome. Conclusions A previous history of laparoscopic salpingectomy with cornual wedge resection could be a risk factor for uterine rupture in pregnant women. Sonographers should be alert to this potential risk in pregnant women with a history of laparoscopic salpingectomy with cornual wedge resection even in asymptomatic patients.

Ultrasound of Fetal Cardiac Function Changes in Pregnancy-Induced Hypertension Syndrome

“…In addition, the systolic fractions of both the left and right ventricles of the fetuses in the hypertension group were significantly higher than those of the fetuses in the normal group, suggesting that PIH patients are associated with varying degrees of impact on fetal cardiac function, which may presumably be attributed to the early changes in blood flow in patients with PIH, hypercoagulability of the blood, increased viscosity of the blood, and spasm of the small arteries throughout the patient's body, leading to impaired cardiac function in both the mother and the fetus [ 12 ]. Furthermore, the hypertension group had significantly lower neonatal weights versus the normal group, which may be attributable to the constriction and narrowing of the spiral artery and the target vessel of the placenta, resulting in the reduction of blood flow in the small spiral arteries of the meconium layer, ischemia, and hypoxia in the intervillous space and small vessels of the meconium, thereby compromising the growth and development of the fetus and causing fetal weight loss [ 13 , 14 ]. Sound maternal health care, proper diet, and maintenance of a positive psychological state can prevent the development of PIH in pregnant women to achieve timely and accurate judgment, prevention, and aggressive treatment, which are considered effective in reducing maternal and infant morbidity and mortality [ 15 ].…”

Third trimester asymptomatic uterine rupture with ballooning of fetal membranes, case report

“…al that described a 39-year-old woman diagnosed with asymptomatic uterine rupture at 22 weeks gestation during a routine second trimester ultrasound. 39 This patient was managed conservatively, and repeat Cesarean was performed at 34 weeks 1 day with positive maternal and fetal outcomes. 39 Like our case, the patient described in Tong et.…”

“…39 This patient was managed conservatively, and repeat Cesarean was performed at 34 weeks 1 day with positive maternal and fetal outcomes. 39 Like our case, the patient described in Tong et. al had a history of prior Cesarean delivery and shortinterval pregnancy; however, the location of the defect was in the cornua as that patient had a prior cornual wedge resection for an interstitial pregnancy ten months prior.…”

Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature

“…These cases offer novel treatment strategies for clinical practice. [ 19 , 20 ] There is no standardized surgical treatment for uterine rupture, and the choice of procedure may vary depending on the patient’s and fetal conditions.…”