Uterine contractility after rupture of the gravid uterus: A case report

Abstract

Reprint requests: Laura J. Zuidema, M.D., Department of Obstetrics and Gynecolou, University of Illinois at Chicago, 840 South Wood St., Chicaqo, IL 60612. included one spontaneous abortion and two term vaginal deliveries. The current pregnancy progressed uneventfully. The patient presented to the hospital labor and delivery suite at 4 1 weeks’ gestation after the spontaneous onset of labor. An external electronic fetal monitor was applied and showed uterine contractions every 3 to 4 minutes and a baseline fetal heart rate of 120 bpm. Two hours after admission, the patient began dark red vaginal bleeding and complained of abdominal pain. Five minutes later, the fetal monitor, which had been recording the fetal heart rate at a baseline of 120 bpm, abruptly lost the heart rate signal (Fig. 1). Doptone examination relocated the fetal heartbeat and the rate was 60 to 90 bpm. With a presumptive diagnosis of abruptio placentae, the patient was prepared for an emergency cesarean section. Meanwhile, the uterus continued to contract every 3 to 4 minutes for 10 minutes, after which the external tocodynamometer was removed for the operation (Fig. 2). At the time of operation 2000 ml of freshly clotted blood were found in the abdominal cavity. The placenta and infant were found free-floating in the upper abdomen. The 3068 gm female infant was delivered through the abdominal incision and had Apgar scores of 1 at 1 minute and 3 at 5 minutes. A large rent, measuring 12 by 6 cm, was found in the posterior uterus extending from the fundus down to the cervix and extending out into the right broad ligament. A supracervical hysterec-