Non-scarred Uterus Research Articles

UTERINE RUPTURE IN A HEALTHY UTERUS ASSOCIATED WITH A RETROPLACENTAL HEMATOMA, REPORT OF A CASE AND REVIEW OF THE LITERATURE

Uterine rupture is a complication of childbirth, its relatively rare but its actual frequency is relative to degree of development of the health system of the country where it occurs. The vital prognosis of the mother and that of the fetus are most often at stake, as well as the subsequent fertility of the patient. Its frequency is increased for scarred uteri and increasingly rare for healthy uterus. Through this work, we present an atypical case of uterine rupture occurring in a non-scarred uterus in a context of eclampsia complicating severe preeclampsia in a 31-year-old patient diagnosed intraoperatively. We discuss through this case and the review of literature, the interest of keeping in mind that this complication can threaten any childbirth even when the diagnosis of other complication seems more conclusive the case of a retroplacental hematoma in our case. The clinical warning signs, the risk factors, the diagnostic methodology are crucial to the therapeutic management of this entity.

Complete rupture of the pregnant uterus: A 12-year retrospective study.

To assess the frequency of uterine ruptures, clinical characteristics, and maternal and neonatal outcomes in a tertiary referral center. Information on complete uterine rupture between July 2010 and June 2022 was investigated retrospectively at a tertiary center. There were 42 cases of complete uterine rupture in 144 474 deliveries, with an incidence rate of 0.029%. Twenty-seven cases had a scarred uterus and 15 had an unscarred uterus; Rupture of the lower uterine segment was predominant in the scarred uterus, whereas rupture of the body of the uterus was predominant in the non-scarred uterus (P ≤ 0.001). Newborns with Apgar score of 7 or less at 1 min in the non-scarred uterus group was more than that in the scarred uterus group (P = 0.001). There were no significant differences in the history of gynecologic surgery, induction of labor, mode of delivery, clinical features, maternal outcomes, neonatal weight, preterm birth rate, 5-min Apgar score, or neonatal mortality between the two groups (P > 0.05). The clinical manifestations of uterine rupture are mainly abdominal pain, abnormal fetal heartbeat, or vaginal bleeding. Attention should also be paid to the history of previous uterine surgery. Strict prenatal management, early identification, and aggressive management can help improve maternal and child outcomes. Hysterectomy is not imperative.

A Case Report and Literature Review of Spontaneous Uterine Rupture in Mid-Pregnancy in a Non-Scarred Uterus

A Case Report and Literature Review of Spontaneous Uterine Rupture in Mid-Pregnancy in a Non-Scarred Uterus

Placenta accreta on non-scarred uterus: About a case

Placenta accreta is an abnormally adherent placenta (abnormal adhesion of the placenta to the myometrium), due to the localized or diffuse absence of the decidua basalis. Its incidence increases with increasing cesarean section rates. Placenta accreta in a non-scarred uterus is very rare but remains possible due to other risk factors which are age, smoking, placenta preavia and finally invasive endouterine procedures. Among its consequences, we first note the hemorrhage of delivery which can be associated with significant maternal morbidity and mortality, uterine rupture and also the invasion of adjacent organs by the placental trophoblast. We report an interesting case of placenta accreta on a non-scarred uterus discovered during a planned cesarean section for placenta previa. This is a 41-year-old patient with no history of scarred uterus, 5th procedure, 3rd parity, with history of spontaneous miscarriage cured at 2 months, pregnant at 39 weeks, unmonitored pregnancy, admitted to the maternity emergency room for two days before for delivery method where the parturient benefited from a clinical examination and an obstetric ultrasound showing a completely covering anterior placenta, amniotic fluid of normal quantity and an estimate of the fetal weight at 2800g, then scheduled for a cesarean section. The diagnosis of placenta accreta is made during cesarean section. We opted for radical treatment. Placenta accreta is a pathology at risk of serious hemorrhagic complications during pregnancy and the postpartum period. This should encourage us to systematically search for ultrasound criteria for placenta accreta. The ultrasound report, in these patients, must explicitly mention this. Adequate care in the presence of a multidisciplinary team makes it possible to limit the mortality and morbidity associated with this pathology.

Risk prediction of placenta previa based on the distance from the lower edge of the gestational sac to the internal cervical os in early pregnancy.

To explore the relationship between the distance from the lower edge of the gestational sac to the internal cervical os in early pregnancy and placenta previa. A prospective cohort study of women who underwent pregnancy examination in Weifang People's Hospital or Sunshine Union Hospital from January 2020 to June 2021. The distance from the lower edge of the gestational sac to the internal cervical os was measured at 5-6 weeks' gestation. There were 86 women with distance < 2.5 cm, and 105 women with distance ≥ 2.5 cm were randomly selected. There were 92 cases of scarred uterus and 99 cases of non-scarred uterus among the 191 women. They were divided into six groups according to the distance: (1) < 1.0 cm; (2) 1.0 cm to < 1.5 cm; (3) 1.5 cm to < 2.0cm; (4) 2.0 cm to < 2.5 cm; (5) 2.5 cm to < 3.0 cm; (6) ≥ 3.0 cm. All included women were followed-up during pregnancy and pregnancy outcome, and the likelihood ratio of different distances in early pregnancy was calculated and risk stratification was performed, and ROC curve was constructed. There were 15 women in the included studies who were lost to follow-up, 47 had a scarred uterus with placenta previa and 29 had a non-scarred uterus with placenta previa after delivery at 28 weeks or later. The distance from the lower edge of the gestational sac to the internal cervical os in early pregnancy of the scarred uterus < 1.5 cm, and the likelihood ratio was ∞; and the distance ≥ 3.0 cm, the likelihood ratio was 0. The distance from the lower edge of the non-scarred gestational sac to the internal cervical os < 1.0 cm, and the likelihood ratio was ∞; and the distance ≥ 3.0 cm, the likelihood ratio was 0. The ROC curve showed that when the area AUC under the curve was 87%, the optimal diagnostic cut-off value was 2.4 cm. When the distance from the lower edge of the gestational sac to the internal cervical os was < 1.5 cm and the distance between the non-scarred uterus was < 1.0 cm, it eventually developed into placenta previa; the distance from the lower edge of the gestational sac to the internal cervical os in the first trimester of pregnancy between the scarred uterus and the non-scarred uterus was ≥ 3.0 cm, and it would hardly develop into placenta previa. When the distance from the lower edge of the gestational sac to the internal cervical os in early pregnancy was ≤ 2.4 cm, it could be used as a predictor of placenta previa.

Spontaneous uterine rupture at 31 weeks of amenorrhea on unscarred uterus: Case report

Uterine rupture in pregnancy is associated with severe maternal and fetal complications. Although it is a rare event, uterine rupture has been associated with certain risk factors. We present the case of a 30-year-old parturient fourth gesture, third par, all delivered vaginally admited to the emergency room for spontaneous uterine rupture in a non-scarred uterus at 31 weeks of amenorrhea revealed by an a typical misleading digestive symptoms, the patient was immediately operated and put in intensive care unit postoperatively with good maternal and fetal evolution. Uterine rupture in a non-scarring uterusis a rare, unpredictable and serious complication.

Frequency of Placenta Previa in Scarred and Non Scarred Uterus

Introduction: An obstetric complication, Placenta Previa usually arises in the, second and. third. pregnancy trimester. This may result in serious nature of it may cause serious incidences and death rate to the mother. There is a huge risk of placenta accreta, in the pregnant women having placenta previa and prior history of cesarean. Objective: To the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. Material &amp; Method Study design: Descriptive Cross Sectional Study Settings: Department of Obstetrics, Gynecology, Lahore General Hospital, Lahore. Duration: Six months i.e. 1st July 2021 to 31st December 2021 Data Collection procedure: 144 sample size was calculated with 80% power of test and 5% level of significance by taking expecting 5%. Female present with age of 20-40 years with scarred and non-scarred uterus and singleton pregnancy and Gestational age 28 weeks and onwards were included. Second trimester bleeding &amp; scars, primi gravidas patients were excluded from the study. Complete history was taken regarding parity, age &amp;duration of gestation. Data was analyzed using SPSS version 24. For qualitative data like Age groups, Gravidy, previous section was presented as frequency &amp; percentages. For quantitative data like age was presented as mean and SD was calculated. Results: 144 females were included; the mean age was 32.23 ± 12.34 years. Mostly females were belonging to 26-30 years 66(45.8%). Gestational age revealed that 20(13.8%) were between 28-32 weeks, 30(20.83%) were 31-35 gestation week and 94(65.2%) were 36-40 weeks of gestation. Placenta Previa found in previously scarred uterus was 98(68.05%), while it was 46 had previous vaginal delivery. About gravidity, 80 patients were between G2-G4, 54 were between G5-G7 and only 10 were more than G7. Conclusion: Frequency of placenta previa is higher in scared uterus in our study than non-scared uterus. Key words: Pregnancy, Placenta Previa, Frequency, Scarred

Complete Rupture of the Pregnant Uterus: A 10-year Retrospective Descriptive Study.

The goal of this work is to analyze the incidence, etiology, clinical characteristics, maternal and neonatal outcomes of complete uterine rupture during pregnancy. The information of complete uterine rupture between June 2010 and May 2020 was investigated retrospectively at a tertiary center, and included demographic data, delivery characteristics, intraoperative findings, and maternal and neonatal outcomes. The prevalence rate of uterine rupture in the early group (hospitalized from June 2010 to May 2015) and late group (June 2015 to May 2020) was compared and analyzed. There were 37 (0.056%) cases of complete uterine rupture in 66 092 births, including 27 (0.041%) of scar uterus and 10 (0.015%) of non-scarred uterus. High-risk factors for scarred uterine rupture included: previous cesarean section (13, 48.1%), myomectomy (8, 29.6%), corneal pregnancy resection (6, 22.2%), history of uterine rupture (1, 3.7%), and uterus perforation during abortion (1, 3.7%). Compared to the early group, the number of uterine ruptures caused by previous cesarean section was significantly reduced in the late group. Of the 10 patients with non-scarred uterine rupture, 3 (30%) occurred during delivery and 7 (70%) were spontaneous. Among the 37 complete rupture patients, 3 (8.1%) died of uterine scar rupture, 19 (51.3%) cases were reported with fetal/newborn deaths, 5 (13.5%) cases underwent hysterectomy and the rest were treated with uterine repair. Complete uterine rupture often has catastrophic effect on pregnancy outcomes. Obstetrics doctors should be vigilant to identify the risk factors and clinical presentations of uterine rupture during pregnancy. Strict prenatal management is beneficial to improve pregnancy outcomes.

Ruptured ectopic pregnancy in a non-communicating rudimentary horn of a unicornuate uterus: A case report

Uterine rupture in first and second trimester in a non-scarred uterus is usually associated with Mullerian anomalies like rudimentary horn pregnancy. Such rudimentary horn pregnancy is difficult to diagnose antenatally but it carries grave consequences for the mother and fetus. Here is a case of undiagnosed ruptured rudimentary horn pregnancy in unicornuate uterus in Gravida 2 Para 0+1 lady at 18 week gestation who was admitted in Emergency with Shock and diagnosis was confirmed at laparotomy.

Frequency of placenta previa in previously scarred and non scarred uterus.

Objective:To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus.Methods:A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections (37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus) in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008– December 2011.Results:Most patients (47.36%) were between 26-30 years age group, presented with gestational age between 36-40 weeks (70.17%), were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% (37 cases), and frequency in previously scarred uterus was 67.54% (77 cases). Major degree Previa was found in 88 cases (77.19%). There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa (10.67%) from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections.Conclusion:A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus.

Clinical analysis of uterine rupture during pregnancy

To explore the clinical characteristics of pregnant uterine rupture, enhance its early diagnosis rate and improve its prognosis. For this retrospective study, a total of 55 143 delivery cases at Tongzhou District Maternal & Child Health Hospital from January 1, 2003 to May 31, 2012 was analyzed. There were 2490 cases of scarred uterus and 68 cases had uterine rupture. And 62 of them belonged to scarred uterus rupture. And there were 52 653 cases of non-scarred uterus childbirth and 6 of them had rupture. Significant differences existed in the rupture of scarred versus non-scarred uterus and maternal versus primipara women. Uterus rupture usually occurred at the incomplete rupture position of original surgical scar at 39 weeks or more. The scar thickness of lower uterine segment was ≤ 3 mm on ultrasound. Three cases with laparoscopic myoma removal within 1 year had complete rupture at 36-38 weeks. Postpartum hemorrhage incidence was 42.65%. There were two cases of hysterectomy and 11 cases of neonatal asphyxia. For second pregnancy of cesarean section, pregnancy should be terminated before 39 weeks if scar thickness of lower uterine segment is ≤ 3 mm. Late rupture is to be monitored closely for those with laparoscopic myoma removal within 1 year. Meanwhile, we should strengthen the management of migrant and unemployed women.

The Evaluation of Uterine Rupture in 61 Turkish Pregnant Women

Aim: The aim of our study, to evaluate the patients with complete or incomplete uterine rupture which occurred during pregnancy retrospectively and to analyze and present of the risk factors, maternal and perinatal outcomes, and complications. Method: Sixty one patients diagnosed as uterine rupture were investigated retrospectively in our clinic between 1999 and 2009. Result: The incidence of uterine rupture for our department in a ten year period was calculated as 0.12 %. Fifty four patients (88.5%) were in low socioeconomic status. Fifty one (83.6%) patients did not receive any antenatal care. Forty eight (78.6%) of the cases had previous ute rine surgery due to cesarean, myomectomy or metroplasty. Twenty six cases (42.6%) were grand multiparous. Primer repair of uterus was performed in 58 (95.1%) of the patients. Subtotal abdominal hyste rectomy was performed in three patients (4.9%). There were 15 fetal deaths while no maternal death was occurred. Conclusion: Rupture of the pregnant uterus is a major obstetric comp lication that occurs often with no warning signs. Uterine rupture is a potential complication for patients with non-scarred uterus as well as scarred uterus. Grand multiparty is a very important risk factor, especially in patients without uterine scar. Despite to its low rate, uterine rupture is a very important complication for mother and fetus. Early diagnosis, immediate preoperative resuscitation, rapid replacement of blood loss, and urge surgical therapy are very important in treatment of uterine rupture. Hysterectomy is not the first choice in case of uterine rupture management.

Intrapartal posterior cervicoisthmic uterine rupture

Abstract A case is presented of complete intrapartal rupture of an intact, nonscarred uterus in the cervicoisthmic region in a quadripara without a history of cesarean section or other uterine operation, with dorsoposterior high longitudinal fetal head position.

Placenta percreta with spontaneous rupture of an unscarred uterus in the second trimester

BACKGROUND: Rupture of a pregnant uterus occurs most often in a scarred uterus, and spontaneous rupture of a non-scarred uterus in the early second trimester is rare. CASE: A woman with two previous normal vaginal deliveries and no prior trauma to the uterus presented at 16 weeks’ gestation with an acute abdomen due to intraperitoneal hemorrhage. A large rupture of the fundus of the uterus was found. A supracervical hysterectomy was carried out, with subsequent good recovery. The specimen showed placenta percreta. CONCLUSION: Spontaneous rupture of an unscarred uterus, due to placenta percreta, should be considered in cases of acute intraperitoneal hemorrhage, even in early pregnancy.

Rupture of the uterus during labor without apparent cause

Spontaneous uterine rupture at term during labor of a non-scarred uterus under epidural anaesthesia is reported in a 17-yr-old primigravida. This exceptional event may lead to catastrophic maternal and fetal consequences. The authors discuss the prevention and diagnosis of this obstetrical complication.