Fundal Rupture Research Articles

Spontaneous fundal rupture in an unscarred uterus in a female with twin pregnancy after in-vitro fertilization: a case report.

Thirty three years female with twin pregnancy following in-vitro fertilization after 11 years of marriage presented to emergency department with lower abdominal pain at 36 weeks 3 days of gestation and was planned for emergency caesarean section for precious twin pregnancy in labour. She was vitally stable and on palpation of abdomen, there was generalized tenderness along with guarding. All the investigations were within normal limits. Emergency caesarean section was performed under subarachnoid block which revealed a 6×2cm fundal uterine rupture with no active bleeding which was repaired in layers. The babies were extracted with a lower uterine segment incision. First twin cried immediately after birth while the second one needed resuscitation and mechanical ventilation due to perinatal asphyxia. Even though rare in a previously unscarred uterus, uterine rupture can present in different forms and thus, requires vigilant evaluation of the patient and prompt intervention to avoid significant maternal or foetal morbidity and mortality.

Antepartal Spontaneous Complete Fundal Non-Scarred Uterine Rupture in Twin Pregnancy.

A 31-year-old, otherwise healthy patient (G1/P0) had a history of left salpingectomy for ectopic (tubal) pregnancy followed by diagnostic laparoscopy and uterine septal incision. Because of primary infertility, she underwent assisted reproduction (in vitro fertilization/embryo transfer), which resulted in a bichorial-biamniotic twin pregnancy. The further course was uneventful until 36 weeks when she felt pain in the epigastrium, leading her to be admitted to the hospital under suspicion of epigastric hernia. On admission, cardiotocographic and ultrasound findings showed a normal state of pregnancy with a palpable mobile, painless epigastric formation, without contractions and other symptoms. Two days after admission, she developed sudden pain and acute abdomen without labor, so an urgent laparotomy for suspected uterine rupture was performed, revealing a complete (12 cm) fundal rupture ([Fig. 1]) with prolapsed amniotic sac and twin legs. Live eutrophic twins (2710 g/48 cm, Apgar 10/10; 2790 g/48 cm, Apgar 10/10) were delivered through Kerr’s transverse isthmic hysterotomy, the placenta was removed, and a primary two-layer uterine suture was performed. The postoperative course was complicated by febrile puerperium, which was resolved by antibiotic treatment with complete maternal recovery.

Uterine rupture of a patient with rudimentary horn pregnancy at 26th gestational weeks.

Introduction and importancePregnancy of Rudimentary Horn is a type of ectopic pregnancy, that is recognized almost always during surgical treatment of a rupture of the rudimentary horn. This is an obstetric case diagnosed preoperatively by magnetic resonance imaging (MRI).Case presentationWe report the case of a 19-years-old primigravida patient with rupture of rudimentary horn in 26th gestational week. The patient presented with sudden onset severe abdominal pain in the emergency room. Intraabdominal free fluid is detected. To evaluate the etiology of free fluid and location of the gestational sac, an abdominal magnetic resonance imaging (MRI) scan was planned. The decision of emergent laparotomy is made because of sonographic detection of abdominal excessive -concentrated- free fluid, abdominal tenderness, and 2 points decrease of hemoglobin value in the control hemogram. A rudimentary horn pregnancy and fundal rupture of the rudimentary part of the uterus are diagnosed during the surgical procedure. A baby -live- weighing 450 g was delivered. The ruptured rudimentary horn and same-sided tuba uterina were surgically removed.Clinical discussionRudimentary horn pregnancy is a rare ectopic pregnancy. Diagnosis is difficult clinically, even with diagnostic imaging modalities. Identifying both cornuas systematically in all patients increases the detection rate. The absence of continuity between the gestational sac's lumen and the cervical canal on imaging is an important finding.ConclusionDue to the serious maternal and fetal complications, its detection at an early week may be life-saving.

A retrospective case series of rupture uterus during five years period at a rural medical college in West Bengal, India

Background: Rupture of the uterus carries major risk of maternal and perinatal morbidity and mortality especially in the developing world.
 Aims and Objectives: This study aims to identify retrospectively the risk factors leading to uterine rupture through case series and to determine the feto-maternal outcome of such serious clinical condition.
 Material and Methods: A retrospective study was done at Bankura Sammilani Medical College, Bankura, West Bengal, India from January 2014 to December 2018 to observe the incidence, aetiology, management and complications with maternal and foetal mortality and morbidity associated with rupture of the uterus in pregnant women at different gestational periods. The data were obtained from the case record section of the hospital. All rupture uterus cases were included excluding the dehiscence of scarred uterus.
 Results: Twenty-one cases of Rupture Uterus were documented out of total delivery of 43,323 mothers in five years. There was a single maternal death and 15 (71.42 %) unbooked cases. Previous mode of delivery was found to be vaginal in 5 cases (23.8%). Most of the incidences of rupture uterus were scarred uterus (previous caesarean section and repaired uterus) 16 cases (76.19%), prolonged / obstructed labour 4 cases (19%), inductionof labour 1 (4.76%) and spontaneous rupture 1 (4.76%). Most cases were multiparous; site of rupture was in lower uterine segment in 18 cases (85.7%), fundal rupture 2 cases (9.52%) and left lateral 3 cases (14.2%). Bladder injury was in 1 case (4.76 %). Total abdominal hysterectomy was performed in 2 cases (9.52%) andsubtotal hysterectomy were done in 15 cases (71.4%); repair of the ruptured uterus wasperformed in 4 cases (19%). Fever and wound infections were present in 5 cases (23. 8%). Maternal death 1(4.76%) and 3 babies survived with perinatal mortality 18 (85.7%).
 Conclusion: Mandatory antenatal care, prompt diagnosis and safe instrumental delivery may change the rupture uterus incidences.

Unusual Causes of Hemoperitoneum: A Case Series of Fundal and Uterine Horn Rupture

Unusual Causes of Hemoperitoneum: A Case Series of Fundal and Uterine Horn Rupture

Complete asymptomatic fundal rupture of the uterus in the first stage of labor

A clinical case of a complete fundal rupture of the uterus at the first stage of labor of a woman with a uterine scar from a previous cesarean section in the lower uterine segment is addressed in this article. During clinical observation, the patient did not have hemorrhagic and pain syndromes. Operative delivery was performed due to primary uterine inertia. A newborn did not show any signs of asphyxia. During the operation, a rounded defect of 4 5 cm in size, penetrating the uterine cavity, was detected in the uterine fundus. It was sutured with a triple-row suture. The area of the lower segment was thinned to 2 mm, with deformation and defects not detected. In the postpartum period, subinvolution of the uterus was noted. The patient was discharged from hospital in satisfactory condition on the 10th day of the postpartum period.

Unscarred uterine rupture and subsequent pregnancy outcome - a tertiary centre experience.

The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred uterine rupture and in those with a history of uterine rupture MATERIAL AND METHODS: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone fertility-preserving surgery were evaluated. During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in 67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in 60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these, eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36-37 wk. of gestation, and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively. The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be validated in another studies.

Fundal Rupture with Breech Expulsion through it in Primigravida: Role of Destructive Procedure (Decapitation) in Modern Obstetrics

Fundal Rupture with Breech Expulsion through it in Primigravida: Role of Destructive Procedure (Decapitation) in Modern Obstetrics

An Unusual Case of Ruptured Uterus Associated With Placenta Abruption: Case Report

Association of abruption of placenta and ruptured uterus is extremely rare, there were only a few cases described in the past. A 24 year-old woman, G2P1 L0 with history of previous Cesarean Section for obstructed labour and now at 7 months of pregnancy, presented with features of acute abdomen with severe anemia. Her pulse rate was 136 per minute, temperature 36.1o C., respirations 28 per minute, blood pressure 96/50 mm. of Hg. Height of uterus 28 weeks, had tenderness and rigidity over the upper abdomen. She was suspected to have Haemoperitoneum due to ruptured uterus, and laparotomy was performed under IV Ketamine as provision of general anaesthesia was unavailable. Intra-operative findings were Haemoperitoneum, recovery of huge amount of clots from peritoneal cavity, Posterior fundal rupture with intact amniotic sac. A fresh stillborn fetus was delivered from the intact amniotic cavity with clear liquor through the rupture site followed by repair of the rent. She received blood transfusion and recovered without any complication. Laparotomy allowed us to discover this unusual presentation in this patient.

Recurrent spontaneous third-trimester uterine rupture after hysteroscopic resection of myoma: a case report

Uterine rupture is a catastrophic obstetrical emergency with serious effects on both women and fetuses. Operative hysteroscopic procedures can add more risk factor for occurrence of this tragedy. Here, we report a case of spontaneous recurrent rupture uterus at 33 weeks of gestation in a 32 years old woman with previous history of hysteroscopic resection of submucous myoma after development of acute abdomen. Uterine repair of fundal rupture was performed through emergency exploratory laparotomy. Surgeons should explain to their patients the hazards of probable risk of recurrent and multiple uterine rupture in the future pregnancy and to document this discussion in the medical records before proceeding to operative hysteroscopic procedures.

Comments on Case Report-Post B-Lynch Uterine Rupture: Case Report and Review of Literature.

Dear Editors, I read with interest the article ‘Post B-Lynch Uterine Rupture: Case Report and review of Literature’ by Date S et al. published in September–October 2014 issue. Mechanical uterine compression sutures are hysterectomy saving emergency procedure for atonic post partum hemorrhage and these are quite safe with minimal complications. B-Lynch suture was first reported in 1997 in which two parallel sutures are applied, starting from just above the bladder reflection, and are tied after taking over the fundus of the uterus from posterior wall [1]. As mentioned by the authors, there is one case report of spontaneous uterine rupture at 32 weeks after B-Lynch suture where PDS suture was used [2]. After reviewing that case, it is seen that the site of rupture was vertical, at the fundus on left lateral side, and a deep vertical groove was present on posterior wall, which is the position of the compression suture which might have eroded the uterus thus leading to weakening of myometrium. The case reported by the authors Date S et al. is 23-year-old G4P1L1A2 with uterine rupture at four month of gestation. As clear from the figure, the rupture is transverse and at fundus of uterus [3]. It is pertinent to note that this patient is also having history of two abortions. In this patient, other causes of rupture could be either weakening of myometrium due to the evacuation of the uterus for abortions or some uterotonic drug given for illegal abortion in second trimester, which is still common in India. Taking into account the transverse fundal rupture that too at 4 months of gestation the other causes of uterine rupture should be ruled out before labeling B-Lynch suture (which is quite safe and has minimal complications) as a cause for uterine rupture.

Uterine Rupture in Pregnancy following Fall from a Motorcycle: A Horrid Accident in Pregnancy-A Case Report and Review of the Literature.

Uterine rupture is one of the most catastrophic complications during pregnancy. It is a rare complication in developed countries but a frequent cause of maternal and perinatal morbidity and mortality in Africa. Uterine rupture occurs in 1.6% of patients suffering blunt abdominal trauma. Here we report a unique case of complete fundal rupture of the unscarred uterus following fall from motorcycle in 39-week-pregnant mother who was managed with total abdominal hysterectomy and left salpingo-oophorectomy and survived, though fetus died before intervention. We also reviewed similar cases reported from different parts of Africa. This is a preventable complication had the woman been properly instructed on transportation safety during her antenatal care visits.

English

Most of the cases of rupture of uterus occurs in the third trimester of pregnancy or during labour but here we report a thirty five year old women G3, P1+1, LCB 10 years back , mode of delivery by LSCS was admitted in MG ward of Malda medical college, West Bengal, India at 16 weeks of pregnancy with complain of acute abdominal pain, vomiting with clinical sign of shock without vaginal bleeding. Haemoperitoneum and dead fetus outside the uterus was discovered by urgent USG of whole abdomen. Emergency laparotomy was carried out and it revealed haemoperitoneum due to spontaneous rupture of uterine fundus through which fetus and placenta were extruded in peritoneal cavity. Though spontaneous fundal rupture is very rare in early second trimester of pregnancy, it should be taken into consideration in the differential diagnosis of acute abdomen

Rupture of a pregnant unscarred uterus in an early secondary trimester: A case report and brief review

Rupture of a pregnant uterus in early pregnancy and an unscarred uterus are extremely rare, and some non-specific symptoms might appear before this occurrence. We report the case of a multiparous woman (gravida 3, para 2) with uterine fundal rupture in her early second trimester (17+ weeks of gestational age), who presented upper abdominal discomfort and vomiting for 3 days, and progressed into sudden acute abdomen and shock. During emergent laparotomy, the entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Although we could not confirm that the appearance of upper gastrointestinal symptoms and severe vomiting was associated with uterine rupture in this pregnant woman, abdominal symptoms or signs might be a hint or cause of severe catastrophic pregnancy-related complications.

Rupture of intrapartum unscarred uterus at the fundus: a complication of passive cocaine abuse?

Uterine rupture is a potential obstetric catastrophe. We report a case of a gravida 2 para 1 with intrapartum unscarred uterine fundal rupture. Immediate resuscitation, laparotomy and hysterectomy, was done with maternal survival. History of passive cocaine smoke exposure elicited postoperatively was the possible etiology leading to complete fundal rupture. This case is an eye opener as regards to ill effects of drug abuse even though passive. A careful history of drug abuse must be elicited when the common causes of uterine rupture have been excluded or the rupture site is unusual.