Maternal and Fetal Outcomes after Prior Mid-Trimester Uterine Rupture: A Systematic Review with Our Experience

Background and Objectives: Since spontaneous uterine rupture in the mid-trimester is rare, maternal and fetal outcomes in subsequent pregnancies remain unclear. Therefore, this study aimed to examine the maternal and fetal outcomes of subsequent pregnancies after prior mid-trimester uterine rupture. Materials and Methods: A systematic review using PubMed, the Cochrane Central Register of Controlled Trials, and Scopus until 30 September 2021, was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The studies that clarified the maternal and fetal outcomes after prior mid-trimester uterine rupture and our case (n = 1) were included in the analysis. Results: Among the eligible cases, there were five women with eight subsequent pregnancies after prior mid-trimester uterine rupture. The timing of prior mid-trimester uterine rupture ranged from 15 to 26 weeks of gestation. The gestational age at delivery in subsequent pregnancies was 23–38 gestational weeks. Among the included cases (n = 8), those involving prior mid-trimester uterine rupture appeared to be associated with an increased prevalence of placenta accreta spectrum (PAS) (n = 3, 37.5%) compared with those involving term uterine rupture published in the literature; moreover, one case exhibited recurrent uterine rupture at 23 weeks of gestation (12.5%). No maternal deaths have been reported in subsequent pregnancies following prior mid-trimester uterine rupture. Fetal outcomes were feasible, except for one pregnancy with recurrent mid-trimester uterine rupture at 23 weeks of gestation, whose fetus was alive complicated by cerebral palsy. Conclusions: Our findings suggest that clinicians should be aware of the possibility of PAS and possible uterine rupture in pregnancies after prior mid-trimester uterine rupture. Further case studies are warranted to assess maternal and fetal outcomes in pregnancies following prior mid-trimester prior uterine rupture.

Spontaneous Rupture of the Non Gravid Uterus: A Case Report

Uterine rupture can cause serious morbidity and mortality to the women. A complete uterine rupture is a diagnosis made when all three layers of the uterus are separated, while uterine dehiscence is a similar condition in which there is incomplete division of the uterus that does not penetrate all three layers of the uterus. Uterine dehiscence is most often an occult finding in asymptomatic patients. Mostly the uterine rupture is seen in gravid females however it has been reported in non gravid patients as well. Spontaneous uterine rupture is extremely rare to be seen in non gravid patients, but should be included in the differential diagnosis of acute abdomen and shock in a non pregnant woman of any age due to its catastrophic consequences. In non gravid uterus the most common cause of the uterine rupture is pelvic trauma, uterine myomas, infection or uterine carcinoma. We hereby report a case of 44 years old female with previous 4 caesarean sections who came on12th day of her cycle with heavy bleeding, lower abdominal pain and anaemia. She was found to have small fibroids which were blamed for the menorrhagia and she was admitted for the conservative management. She collapsed on day 2 of admission suddenly and after stabilization of the patient her exploratory laparotomy was done and uterine rupture was detected on the right side of the previous scar. The uterus was repaired as the patient refused for hysterectomy. Her post op recovery was uneventful. Her first periods after the surgery was normal with average amount of blood loss. Key words: Uterine rupture, haemorrhage, non -gravid, caesarean, hysterectomy, laparotomy.

Spontaneous uterine rupture during early pregnancy

Spontaneous rupture of the uterus in the first half of pregnancy is rare. According to LS Persianinov (1952), for 262 cases of uterine rupture, 24 (9.1%) occurred during pregnancy, and only 5 of them occurred in the first half.

Spontaneous Uterine Rupture Of Healthy Uterus : About A Case And Literature Review

Uterine rupture in a healthy uterus remains a rare complication of labour. However, given its seriousness in putting the life of the mother and the fetus at risk, it is important to think about it in the presence of any metrorrhagia during labour, even in a healthy uterus. It is more frequent in the case of a scarred uterus. We present a rare case of spontaneous uterine rupture in a healthy uterus in a 28 year old patient with no previous history of pathological history, diagnosed after six hours of delivery due to postpartum haemorrhage. Through this case and the review of the literature, we discuss the extreme caution that must be maintained even in the case of a non-scarring uterus, as well as the clinical signs of appeal, the risk factors, the diagnostic methodology and the therapeutic management of this rare but potentially serious entity.

Successful pregnancy after previous uterine rupture

Uterine rupture is a rare and catastrophic event with high fetal and maternal morbidity rate. It is most commonly seen in scarred uterus. Here we present a case of 30 years old female, gravida 3 para 2 living 0 with previous spontaneous uterine rupture at 28-30 weeks with still birth 3 years ago. She underwent emergency laparotomy with repair. She conceived spontaneously, admitted at 20 weeks of gestational age and close antenatal surveillance was done throughout the pregnancy. Corticosteroids was administered. At 36 weeks elective caesarean was planned, delivering via breech presentation to a live male baby of 2.5 kg, Apgar score of 8/10,9/10 at 1 and 5 minutes.