Abstract
Hemoperitoneum as a result of uterine rupture in a previously unscarred uterus is a rare entity to encounter and a potentially life-threatening condition. Ruptures can occur in a scarred uterus either spontaneously, due to operative manipulations, or with the use of uterotonic medications. In an unscarred uterus, spontaneous ruptures are known with high parity, use of oxytocin, and prolonged, neglected labor. Ruptures can be silent with no symptoms resulting in a delay in diagnosis and a near-miss situation. Here, we report the case of a 25-year-old young female who was referred to our tertiary care hospital in rural central India six hours after full-term vaginal delivery, which was followed by pain in the lower abdomen. She had no history of cesarean section, laparoscopic procedures, or surgical termination of pregnancy, which would have predisposed her uterus to rupture. She was severely pale on arrival, and a contrast-enhanced computerized tomography scan revealed rupture of the left side of the uterus with hemoperitoneum and a large pelvic hematoma. Because the patient was in hemorrhagic shock, she was immediately taken for laparotomy with simultaneous resuscitative measures and blood transfusion on flow. Extensive uterine rupture, extending through the cervix to the round ligament of the left side involving the left lateral uterine wall, with active bleeding from the site of the defect was confirmed. The hematoma was 10 × 10 cm in size and was evacuated, following which peripartum hysterectomy was done. The left ureter was traced and safeguarded while applying the clamp on Mackenrodt’s ligament. The patient recovered completely following the procedure. She was discharged on day 13 in stable condition. She is currently doing well on follow-up and is a good example of a maternal near miss. In this report, we emphasize that, even in the absence of any obvious risk factor, uterine rupture can occur during labor, and monitoring the vitals of patients in the immediate postpartum period is essential to detect and promptly manage this serious condition for preventing maternal mortality.
Highlights
Rupture of a healthy, unscarred uterus is a rare but severe life-threatening condition leading to increased maternal mortality
Several risk factors have been identified for uterine rupture, a history of cesarean section is the most important risk factor, especially in developed countries where the incidence of cesarean section is relatively higher than in developing countries [3]
High parity, prolonged and obstructed labor, uterine manipulation, operative vaginal deliveries, and injudicious use of uterotonics are some of the risk factors
Summary
Rupture of a healthy, unscarred uterus is a rare but severe life-threatening condition leading to increased maternal mortality. Oftentimes the clinical picture is non-specific and a high index of suspicion is required to promptly diagnose and manage the condition for preventing maternal mortality [4] Placental factors such as placenta previa and drugs such as the use of prostaglandin or oxytocin for induction or augmentation of labor may predispose an individual to develop uterine rupture. She was a second gravida with previous vaginal delivery Her chief complaint was pain in the lower abdomen, located on the left iliac region, since the delivery of the child six hours back. She had previously delivered a female child weighing 3.5 kg six years ago, which was a normal full-term vaginal delivery. She was discharged in a stable condition on day 13 of admission
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