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Case Reports
. 2021 Oct 27:32:e00364.
doi: 10.1016/j.crwh.2021.e00364. eCollection 2021 Oct.

Combined vesicouterine rupture during second-trimester medical abortion for fetal abnormality after prior cesarean delivery: A case report

Giuseppe Caruso  1 , Vanessa Paladini  1 , Valentina D'ambrosio  1 , Antonella Giancotti  1 , Maria Grazia Piccioni  1 , Innocenza Palaia  1 , Violante Di Donato  1 , Giorgia Perniola  1 , Roberto Brunelli  1 , Francesco Pecorini  1 , Ludovico Muzii  1 , Maria Scudo  1
Affiliations
Case Reports

Combined vesicouterine rupture during second-trimester medical abortion for fetal abnormality after prior cesarean delivery: A case report

Giuseppe Caruso et al. Case Rep Womens Health. .

Abstract

Introduction: The use of mifepristone and misoprostol for the induction of a second-trimester abortion is common and effective. However, its safety in women with previous cesarean delivery is still controversial, given the potentially higher risk of uterine rupture.

Case presentation: We present the case of a 30-year-old woman (G2P1) who experienced vesicouterine rupture with escape of the dead fetus into the bladder during second-trimester induced abortion after prior cesarean delivery. She was successfully managed with conservative surgery.

Conclusion: This case highlights the challenges of early diagnosis of vesicouterine rupture during second-trimester medical abortion. We argue that a close monitoring of patients with prior cesarean section is mandatory, particularly if uterine contractions suddenly stop or the fetal head fails to descend. A prompt conservative surgical approach allows preservation of fertility.

Keywords: Bladder rupture; Mifepristone; Misoprostol; Second-trimester abortion; Uterine rupture.

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Figures

Fig. 1
Fig. 1
a. Retroplacental abruption b. Discontinuity of the anterior uterine wall (white arrow) c. Over-distended bladder containing fetal parts. d. Foley catheter coming out through the bladder tear (black arrow).
See this image and copyright information in PMC

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