Abstract
Uterine gangrene is a rare event during pregnancy. Here, we report the case of a 22-year-old patient pregnant in her second trimester presenting with premature rupture of membranes and a low-lying placenta. Hysterotomy was done to evacuate the pregnancy. The procedure was complicated by hemorrhage so bilateral uterine arteries and the left internal iliac artery were ligated to control the bleeding. She continued to run a fever in spite of antibiotics and on the 11th postoperative day, the patient developed signs of septicemia. Abdominal re-exploration was done revealing a gangrenous uterus with signs of peritonitis. Subtotal hysterectomy was done. The patient was discharged from the hospital in good health on the 10th post repeat laparotomy day.
Highlights
Uterine gangrene is a rare event during pregnancy
In cases of abnormal placentation and chorioamnionitis with evidence of septicemia, all these factors predispose to occlusion of the uterine blood supply resulting in marked uterine ischemia
Incision of the uterine wall revealed that the myometrium was black in color (Figure 3), the cavity was filled with offensive pus; the decidua was black in color and covered with a pyogenic membrane
Summary
Uterine gangrene is a rare event during pregnancy. Here, we report the case of a 22year-old patient pregnant in her second trimester presenting with premature rupture of membranes and a low-lying placenta. Second trimester premature rupture of membranes (PPROM) occurs in less than 1% of pregnancies.[2] Subsequent chorioamnionitis can lead to severe complications, like septicemia and pelvic thrombophlebitis if the patient is left neglected.[3] Pelvic devascularization is one of the conservative methods for management of intraoperative hemorrhage due to low-lying or morbidly adherent placenta.[4] In cases of abnormal placentation and chorioamnionitis with evidence of septicemia, all these factors predispose to occlusion of the uterine blood supply (either uterine or ovarian vessels) resulting in marked uterine ischemia.
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