Spontaneous Uterine Rupture in a Preterm Pregnancy following Myomectomy.

Claire Sutton,Christopher Griffin,Jade Acton,Prue Standen

doi:10.1155/2016/6195621

Claire Sutton, Christopher Griffin + Show 2 more

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https://doi.org/10.1155/2016/6195621

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Abstract

A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm. The neonate was transferred to the Special Care Nursery for neonatal care. The patient had an uncomplicated postoperative course and was discharged home three days following delivery. This is an unusual presentation of uterine rupture following myomectomy where the fetal arm had protruded through the uterine wall.

Highlights

Uterine rupture is an obstetric emergency that can result in significant maternal and fetal morbidity and mortality
The most important contributing risk factor is the presence of a scarred uterus, usually secondary to uterine surgery such as a myomectomy or caesarean section
We report a case of spontaneous antenatal uterine rupture at gestation of 32 weeks and 2 days, originating from a myomectomy scar

Summary

Introduction

Uterine rupture is an obstetric emergency that can result in significant maternal and fetal morbidity and mortality. It is defined as a full-thickness separation of the uterine wall and overlying visceral peritoneum [1]. The most important contributing risk factor is the presence of a scarred uterus, usually secondary to uterine surgery such as a myomectomy or caesarean section. We report a case of spontaneous antenatal uterine rupture at gestation of 32 weeks and 2 days, originating from a myomectomy scar. The fetal arm was seen on ultrasound to be protruding out through the uterine rupture on the background of a reactive fetal cardiotocogram (CTG)

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