A case report of delayed diagnosis of uterine rupture following vaginal delivery

Abstract

Introduction: A uterine rupture is still a rare event but its incidence appears to be increasing, even in the unscarred uterus. In our case, the uterine rupture presented itself in an unscarred uterus and after a vaginal delivery. Case report: A 36 years old women with three previous normal deliveries, comes to our hospital for assistance at 32 weeks with a poor pregnancy surveillance. After diagnosing Gestational Diabetes, she is admitted for therapeutic adjustment. She is discharged after achieving metabolic control but comes back a few days later with a stillbirth, born by vaginal delivery. Six days later she presents with: fever and pain; anemia leukocytosis and a heterogeneous image on ultrasound. However, was decided to start intravenous antibiotics before choosing for surgery. Her condition worsens and an exploratory laparotomy is done: a posterior uterine wall rupture that required a hysterectomy. Conclusion: Risk factors for uterine rupture were present (maternal age over 35, higher parity, fetal macrosomia) but the absence of any symptom, the normal examination after delivery, and mostly, an unscarred uterus, resulted in a delay in the diagnosis of more than one week, leading to catastrophic consequences: hysterectomy. This case reminds us that uterine rupture happens not only in case of previous uterine surgery, and these cases seem to be increasing because of the increase in other risk factors: advanced maternal age and diabetes with resulting fetal macrosomia.