Uterine rupture: A rare complication of repeated cervical cerclage

Abstract

Uterine rupture is an obstetric crisis with potentially catastrophic fetal and maternal consequences. Uterine rupture in contemporary practice correlates with increased rates of cesarean section, with scarred uteri now being the most common etiology. We encountered a multigravida parturient with a cervical cerclage repeated in three consecutive pregnancies. She presented in early labor and removal of the cervical stitch with spontaneous progress of labor led to an unexpected cascade of events that included maternal tachycardia, fetal distress and regression of station at full dilatation. An urgent laparotomy with cesarean delivery was performed and intraoperatively we found there was hemoperitoneum and complete uterine tear extending from the cervix to the lower segment of the uterus on the left side. Repair of the tear and immediate management resulted in an uneventful postpartum recovery for both the mother and the baby. A literature search turned up just three such reported cases, a testimony to the rarity of this condition. This case highlights an unexpected side effect of a simple procedure that is often taken for granted. It also reiterates the need for medical and paramedical staff to think, anticipate and act promptly even in the most dreadful situations like this of a rupture in an unscarred uterus.