Abstract
In this case study we describe an obstetric emergency of complete intrapartum left-lateral uterine avulsion, with posterior cervical rupture in a 31-year-old secundipara, following vacuum extraction. To the best of our knowledge, a similar case has not been previously reported in the literature. A live macrosomic male neonate was delivered by two tractions, with lateral episiotomy, and with shoulder dystocia that was relieved by McRoberts’ and Resnik’s maneuvers (Apgar score 7.8, birth weight/length 4640/57).In our patient, the risk factors for avulsion and concomitant posterior cervical rupture included prolonged second stage of labor, delivering a macrosomic neonate in a secundipara with deflexion (parietal) in a cephalic presentation along the distended and thinned posterior uterine wall. Urgent total hysterectomy was performed in dramatical circumstances due to complete unilateral avulsion and cervical rupture, with continuous aortal compression, volume replacement and intact coagulation, which certainly contributed to the good final maternal outcome.
Highlights
Intrapartum complications, such as uterine rupture (~1:1500 deliveries), are associated with a high perinatal mortality and morbidity
Obstetric avulsion has been reported in only a few cases in the early literature, in the form of complete manual avulsion of the uterus, uterine tube and ovaries, [8] and intrapartum avulsion of the round ligament
Uterine avulsion from the surrounding structures during pregnancy and delivery can be associated with altered topographic intra-abdominal relations, previous operative procedures, fibroids, or with excessive force acting upon the gravid uterus such as accidents, blunt injuries, or iatrogenic causes [7] and other intrapartum lesions
Summary
Intrapartum complications, such as uterine rupture (~1:1500 deliveries), are associated with a high perinatal mortality (neonatal 50% and maternal 50%) and morbidity. A higher rate of uterine rupture is recorded in women with previous injuries and operations such as cesarean section or myomectomy. Uterine avulsion (Fr. décollement) is a very rare and severe complication mostly presenting with signs of hemorrhagic shock and is generally associated with blunt abdominal or pelvic trauma and potential lethal outcome due to polytrauma. [4,5] There are only a few literature reports of obstetric uterine avulsion (during pregnancy, at delivery and in the puerperium), mostly in association with blunt trauma, and very rarely occurring during or after delivery. A case is described of complete left-sided intrapartum uterine avulsion with posterior cervical rupture in a secundipara following vacuum extraction. To the best of our knowledge, a similar report has not been previously reported
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