Diagnosis Of Uterine Rupture Research Articles

Diagnosis of Uterine Rupture on CT

A 34-year-old woman with seven previous cesarean deliveries and a history of scant prenatal care presented at 32 weeks' gestation with constant, vague lower abdominal pain that had worsened over the past day. Her vital signs were normal, and the examination was notable for tenderness in both lower quadrants. Laboratory tests revealed a hematocrit value of 39% and a white-cell count of 18,300 per cubic millimeter with 8% bands. The fetal status was reassuring, on the basis of a reactive heart-rate tracing with rare variable decelerations. Infrequent uterine contractions were noted, and the cervix was long and closed with no . . .

Uterine rupture: the road ahead?

The worldwide increase in caesarean sections, as well as that in laparoscopic and hysteroscopic surgery, augments the risk for women to suffer a uterine rupture. Also the use of misoprostol for the termination of pregnancy and induction of labour, particularly in developing countries, contributes to the greater incidence of uterine rupture. In developing countries, again, neglected obstructed labour remains a very frequent cause of uterine rupture. Diagnosis of uterine rupture may be difficult and, if made too late, serious and even devastating complications may follow, culminating in infant and/or maternal death. A high index of suspicion is indicated when dealing with women at risk. Options in terms of managing uterine rupture include simple repair of the tear, subtotal, and total hysterectomy. Counselling women before and after surgical interventions on the genital tract, especially caesarean section on request, should include information concerning the subsequent risk of uterine rupture.

MRI diagnosis of spontaneous uterine rupture of an unscarred uterus

Spontaneous uterine rupture is a rare, potentially catastrophic complication of pregnancy, and its prompt diagnosis and treatment are essential in limiting morbidity and mortality. Clinical diagnosis is difficult and relies heavily on diagnostic imaging. Radiological diagnosis is also often difficult with most documented cases involving the use of ultrasound and computed tomography. Although magnetic resonance imaging (MRI) is being used more frequently to assess patients, there are few reports illustrating the utility of MRI and its advantages over other imaging modalities in the diagnosis of uterine rupture. This report documents a case of spontaneous uterine rupture diagnosed by MRI in a postpartum patient with an unscarred uterus.

Uterine rupture in midtrimester abortion. A complication of gemeprost vaginal pessaries and oxytocin. Case report

The 1st reported case of uterine rupture in pregnancy termination associated with the administration of gemeprost and oxytocin involved a 24-year-old UK women with 3 previous uncomplicated pregnancies. Pregnancy termination, performed at 16 weeks of gestation, involved the insertion of 1 mg gemeprost vaginal pessaries into the posterior fornix at 3-hour intervals. A total dose of 5 mg of gemeprost was administered in the 1st 24 hours. Another treatment course was instituted the following day, and the patient's cervix remained closed despite the onset of contractions and slight vaginal bleeding. During the 2nd course of 5 pessaries, the patient also received 4 15 mg doses of intramuscular papaveretum. On the 3rd day, a intrauterine pregnancy was visible on ultrasound scan, but no fetal heartbeat was detected. A total dose of 50 IU of oxytocin was then administered over a 22-hour period. The diagnosis of uterine rupture was made on day 4 when vaginal examination revealed a large bulging lower uterine segment anteriorly and a closed cervix posteriorly. The patient's hemoglobin concentration had fallen from an admission value of 11.4 g/dl to 6.5 g/dl. Laparotomy revealed a large left broad ligament hematoma extending anteriorly into which the fetus had been extruded. Total abdominal hysterectomy was required. The uterine rupture is assumed to have occurred during the 2nd course of gemeprost. The absence of previously reported cases of gemeprost-associated uterine rupture may reflect the rarity of this method of pregnancy termination in the 2nd trimester.

The role of epidural anesthesia in trial of labor.

In 1988, the American College of Obstetricians and gynecologists (ACOG) decided that vaginal delivery after a previous cesarean delivery (trial of labor, TOL) was an acceptable alternative to elective repeat cesarean delivery. ACOG stated that there appears to be no absolute contraindication to epidural anesthesia for labor during TOL. The concern is that should there be a uterine rupture, would the epidural anesthesia mask the abdominal pain? The incidence of complete rupture with trial of labor is reported to be 0.3-0.5%. In our review of 10,967 patients undergoing TOL, only 22% of complete ruptures presented with abdominal pain; 76% presented with signs of fetal distress diagnosed by continuous electronic fetal monitoring. Thus abdominal pain is an unreliable sign of complete uterine rupture. There have been no reports of epidural anesthesia delaying the diagnosis of uterine rupture. In the review of 10,967 patients undergoing TOL, there were no maternal deaths and only nine fetal deaths secondary to complete uterine rupture. The literature strongly suggests that epidural anesthesia is safe in TOL even when oxytocin is used for augmentation of labor.

Uterine Rupture

Uterine rupture is a sudden, unforeseeable event that carries a high rate of maternal and perinatal mortality. When the diagnosis of uterine rupture is suspected, prompt surgical intervention with an experienced pelvic surgeon and blood product replacement should be considered. At the time of uterine rupture, the patient should be evaluated for possible repair or hysterectomy. It appears, based on the aforementioned information, that repair is a reasonable consideration. In those patients who have undergone a repair, early delivery by elective cesarean after assessment of fetal lung maturity at or around 36 weeks gestation would appear prudent. In those patients with a prior cesarean, continuous electronic fetal monitoring to detect intrapartum fetal distress would appear prudent. In these patients fetal distress is the most common sign or symptom of uterine rupture and frequently precedes any other clinical manifestations of this complication.

Vaginal sonography in the diagnosis of uterine rupture.

Vaginal sonography in the diagnosis of uterine rupture.

Uterine rupture: Are intrauterine pressure catheters useful in the diagnosis?

The usefulness of the intrauterine pressure catheter in the diagnosis of uterine rupture was assessed by review of 76 cases of uterine rupture, 39 of which were monitored with an intrauterine pressure catheter. The classic description of a loss of intrauterine pressure or cessation of labor was not observed in any of the patients. However, an increase in baseline intrauterine pressure was observed in four patients with an intrauterine pressure catheter. The increase in pressure was associated with severe variable decelerations such that by itself the intrauterine pressure catheter added little to the diagnosis of uterine rupture.

Ruptured uterus: sonographic diagnosis.

Sonography was able to suggest a diagnosis of uterine rupture by demonstrating intra- or extraperitoneal hematoma in the correct clinical setting. A pelvic abscess complicating a uterine rupture was seen in one case. Previous uterine scar, use of prostaglandins for induction of labor, trauma with a currette, and cornual pregnancy were the implicated etiologic factors. Although the rupture site was never directly visualized by sonography, the combination of sonographic and clinical findings was strongly suggestive of the correct diagnosis.

Infant survival with prolonged uterine rupture

RI'PTI‘RE OF THE UTERUS isoneoftherarestobstetric emergencies yet accounts for 5% of maternal deaths in the United States.’ Uterine rupture of traumatic origin may occur secondary to instrumentation, intrauterine manipulation, injudicious use of oxytocin or prostaglandin agents, unattended labors complicated by abnormal presentations, excessive fundal pressure, or abdominal trauma. Spontaneous uterine rupture has been most commonly attributed to previous uterine operation but has also been reported in congenital uterine anomalies, cornual or angular pregnancies, molar pregnancies, placenta percreta, and even previously uncomplicated pregnancies.‘-” The vast majority of spontaneous ruptures occur intrapartum, and uterine rupture of a previously unscarred uterus prior to labor is a rare event.“. ’ This report concerns a case of spontaneous uterine rupture with partial fetal expulsion that occurred prior to labor. The diagnosis of uterine rupture was delayed because of symptomatology beginning 9 weeks prior to intervention.

The diagnosis of uterine rupture

1. 1. In the Obstetrical Department of the Hadassah University Hospital, Jerusalem, there were, during a period of ten years thirteen cases of uterine rupture among a total of 9,079 deliveries, i.e., an incidence of 1:698 or 0.14 per cent. 2. 2. In spite of statistical data in the literature to the contrary, the number of cases decreased by half during the second part of the decade. 3. 3. All thirteen cases occurred in multiparae. 4. 4. Maternal mortality was 46.1 per cent (6:13). Fetal mortality 100 per cent. 5. 5. We had eight cases of spontaneous rupture, three of violent rupture and two cases in connection with a not very careful use of pituitary extract.

A case of spontaneous rupture of the uterus before childbirth after a caesar section

Uterine rupture is most commonly seen during labor and relatively rare before delivery. A large percentage of mortality with them, reaching up to 80% for the mother, and almost 100% for children, makes us pay special attention to the etiology and diagnosis of uterine rupture in general, in particular spontaneous, in each case of this kind of complication.