Uterine rupture during pregnancy

Abstract

Objective: A review of contemporary knowledge about uterine rupture during pregnancy, followed by a case-report of a patient with uterine rupture during pregnancy without an uterine scar.

Design: Review and case report.

Setting: Clinic of Obstetrics and Gynecology, University Hospital, Hradec Králové; Department of Gynecology and Obstetrics, Hospital Náchod.

Case report: We present a case of an uterine rupture of a uterus without a scar from previous surgery. A patient in 33. week of pregnancy with stillborn fetus was administred to our hospital. While inducing the labor, the patient showed signes of shock, fetus was no longer present in uterus. An C-section was performed, but the stillborn baby was placed in abdominal cavity, with an abrupted placenta. Large uterine rupture was spotted, therefore a hysterectomy was performed.

Conclusion: Uterine rupture during pregnancy is an urgent state. The incidency of uterine rupture is rising accordingly with the growing number of C-sections. However, it is important to include uterine rupture into differential diagnostics also in cases with other risk factors. The key to successful diagnosis is ultrasound examination and correct evaluation of clinical state, other imaging methods are less suitable because of time delay. Together with the change of major cause of uterine rupture, the approach to treatment has changed as well. If possible, a uterus-saving procedure is preferred. The aim of this case-report is presentation of a rare case of uterine rupture in an scar-free uterus. It also shows how troublesome diagnostics of uterine ruptures can be.

Keywords: peripartal hysterectomy; risk factors; scar after cesarean section; uterine rupture in pregnancy.