Circumstances of occurrence of uterine ruptures treated in a national reference maternity department in Benin from 2015 to 2019

Background: Uterine rupture is an obstetric disaster and a major concern for the obstetrician in an African environment because of the insufficient technical support. Objective of current study was to study the circumstances of occurrence of uterine ruptures.Methods: The study was carried out at the university clinic of obstetrics and gynecology of CNHU-HKM in Cotonou. This was a descriptive and cross-sectional study with retrospective collection from January 1, 2015 to December 31, 2019. We made an exhaustive recruitment of all the patients treated in the department for uterine rupture during the study period. The study variables were socio-demographic and clinical characteristics. Data confidentiality and the anonymity of women were respected.Results: The study involved 85 cases of uterine rupture. Patients were relatively young with a mean age of 30±15.02 years. Women profile was that of populations with unfavorable socio-economic conditions. The circumstances of discovery were multiparity equal to or greater than 4 (43.5%), scarred uterus (32.9%), non-use of partogram (97.6%), osseous dystocia (10.9%) and fetal dystocia with fetal macrosomia (21.2%) and dystocic presentation (15.3%).Conclusions: This study identified epidemiological and clinical characteristics related to the circumstances of known uterine ruptures occurrence. A preventive and anticipatory oriented approach can reduce the frequency of that obstetric tragedy, the adequate management of which is often uncertain in Benin.

Role of Decapitation in Management of A Case of Complete Shoulder Dystocia with Rupture Uterus - A Case Report

Complete Shoulder dystocia in the presence of scarred uterus is an acute obstetrical emergency and if not properly handled can lead to serious fetal and maternal complications. A G5P4AO previous II cesarean sections, presented in emergency after delivery of fetal head and impacted shoulders, at a small private clinic in a village, four hours back. On laparotomy, there was uterine rupture from the previous uterine scar along with posterior bladder wall rupture . The shoulder dystocia was relieved by decapitation and breech extraction abdominally. Subtotal hysterectomy and repair of the bladder wall was done. This case highlight the dilemma of lack of regular antenatal care and maternal education, malpractices by untrained health professionals and time lapse in referral system that is still a very serious and major issue in developing countries like Pakistan . Keywords: Shoulder dystocia, obstructed labor, and uterine rupture

Effect of Low-Frequency Electric Pulse Technique Combined with Carboprost Methylate Suppositories on Recovery of Gastrointestinal Function and Postoperative Complications of Patients with Scarred Uterus Undergoing Secondary Cesarean Section

The study aims to explore the effect of low-frequency electric pulse technique combined with carboprost methylate suppositories on recovery of gastrointestinal function and postoperative complications of patients with scarred uterus undergoing secondary cesarean section (C-section). The clinical data of 120 patients with scarred uterus undergoing secondary C-section treated in our hospital from February 2019 to February 2020 were retrospectively analyzed, and the patients were equally divided into experimental and control groups according to their admission order, where each group included 60 patients. After the operation, patients in the control group received routine nursing and conducted breastfeeding, and carboprost methylate suppositories were used for postoperative hemostasis. Those in the experimental group received low-frequency electric pulse technique for comprehensive treatment to compare their coagulation function indicators, recovery of gastrointestinal function, incidence rates of postoperative complications, and involution of uterus. No significant between-group differences in patients’ general information such as gestational weeks, gravidity, and number of times receiving C-section were observed ( P > 0.05 ). Compared with the control group after the operation, patients in the experimental group obtained significantly better coagulation function indicators ( P < 0.001 ) and presented better gastrointestinal function recovery ( P < 0.001 ), significantly lower incidence rates of postpartum hemorrhage, retention of urine, deep venous thrombosis of lower limb, rupture of uterus, and endometrial cavity fluid ( P < 0.05 ), and significantly better involution of uterus ( P < 0.001 ). In conclusion, combining low-frequency electric pulse technique with carboprost methylate suppositories can lower the incidence rates of postoperative complications for patients with scarred uterus undergoing secondary C-section, improve their coagulation function, promote the recovery of gastrointestinal function, and present the desirable involution of uterus, which should be promoted in practice.

Uterine rupture at the fundus during labor: A case report

Uterine rupture is a rare but catastrophic complication seen in obstetrical practice. The most crucial predisposing factor is previous caesarean scar and it is generally being reported during labor in patients with scarred uterus. Although rare, rupture of an unscarred uterus is one of the most terrible obstetric complications, resulting in maternal and fetal jeopardy. Shoulder dystocia is one of the most difficult complications of labour that is unpredictable and therefore unpreventable. In neglected cases, grave maternal complications like obstructed labour and rupture of uterus can occur. Very rarely, the reverse, uterine rupture leading to shoulder dystocia can also occur. The present case is reported to emphasize the importance of early recognition of this condition. A 32 year old gravida 5 para 2 live 2 abortion 2 with 9 month period of gestation presented to labor room with shoulder dystocia, with history of fundal pressure. After delivery of head, pain subsided and the trunk failed to deliver. Her previous two deliveries were by normal vaginal delivery 8 years and 5 years back respectively. She had previous two abortions 6 years and 3 years back respectively. Both were spontaneous expulsion followed by dilatation and curettage. On examination, clinical diagnosis of rupture uterus was made and patient was taken up for laparotomy. On laparotomy, fetal body and limbs along with the placenta was seen lying in the abdominal cavity and head was in uterus. Baby of 2.34 kg was extracted as breech. A linear rupture of around 10-12 centimeter was present at fundo-posterior region. Uterus was repaired in 3 layers and bilateral tubal ligation was done. Patient was discharged on post- operative day 10 without any complications.In women with high risk for uterine rupture, delivery must be conducted at tertiary hospitals where facilities for emergency caesarean is available. In these patients, if shoulder dystocia occurs, rupture of the uterus must be suspected as an underlying cause. Assisted fundal pressure during delivery can result in trauma even to the unscarred uterus and cause traumatic uterine rupture. Early diagnosis is vital if maternal morbidity is to be reduced.

A clinical case of the uterine complete rupture along with the previous scar during pregnancy with atypical clinical features

This article presents an unusual case of rupture of the scarred uterus at 36-37 weeks of gestation. The patient presented with pain in the pubic and hip joint area, growing stronger while her walking, seated and changing position. No clinical manifestations of hemorrhagic shock were observed. External obstetric examination revealed a normotonic uterus and satisfactory fetus condition. Provocation tests were conducted to exclude subluxation of the pubic joint. Pubic symphysis diastasis palpation, long dorsal sacroiliac ligament palpation, P4 test, Patricks test, and the modified Trendelenburg test were negative. Pelvic examination revealed sharp pain in lower uterus segment. Ultrasound scan revealed deformation and thinning of the scar up to 1 mm, and no abnormalities in pubic symphysis. A threatening uterine rupture was diagnosed, and emergency cesarean section was performed. Intraoperative examination showed that the scar located in the lower segment consisted of connective tissue. In addition, there was a 4 5 cm scar defect with the overlying amniotic sac, no hemorrhage being noted. After removing the fetus, scar excision was performed. The uterine defect was repaired with a double layer running-locking suture. The patient was discharged from hospital on day 5 of postpartum period. The infant was exposed in the neonatal intensive care unit to provide an early developmental care.

Epidemiology of uterine rupture among pregnant women in China and development of a risk prediction model: analysis of data from a multicentre, cross-sectional study

ObjectivesTo describe the epidemiology of uterine rupture in China from 2015 to 2016 and to build a prediction model for uterine rupture in women with a scarred uterus.SettingA multicentre cross-sectional survey conducted in 96 hospitals across China in 2015–2016.ParticipantsOur survey initially included 77 789 birth records from hospitals with 1000 or more deliveries per year. We excluded 2567 births less than 24 gestational weeks or unknown and 1042 births with unknown status of uterine rupture, leaving 74 180 births for the final analysis.Primary and secondary outcome measuresComplete and incomplete uterine rupture and the risk factors, and a prediction model for uterine rupture in women with scarred uterus (assigned each birth a weight based on the sampling frame).ResultsThe weighted incidence of uterine rupture was 0.18% (95% CI 0.05% to 0.23%) in our study population during 2015 and 2016. The weighted incidence of uterine rupture in women with scarred and intact uterus was 0.79% (95% CI 0.63% to 0.91%) and 0.05% (95% CI 0.02% to 0.13%), respectively. Younger or older maternal age, prepregnancy diabetes, overweight or obesity, complications during pregnancy (hypertensive disorders in pregnancy and gestational diabetes), low education, repeat caesarean section (≥2), multiple abortions (≥2), assisted reproductive technology, placenta previa, induce labour, fetal malpresentation, multiple pregnancy, anaemia, high parity and antepartum stillbirth were associated with an increased risk of uterine rupture. The prediction model including eight variables (OR >1.5) yielded an area under the curve (AUC) of 0.812 (95% CI 0.793 to 0.836) in predicting uterine rupture in women with scarred uterus with sensitivity and specificity of 77.2% and 69.8%, respectively.ConclusionsThe incidence of uterine rupture was 0.18% in this population in 2015–2016. The predictive model based on eight easily available variables had a moderate predictive value in predicting uterine rupture in women with scarred uterus. Strategies based on predictions may be considered to further reduce the burden of uterine rupture in China.

Uterine Rupture at a Site Distant From Old Scar: An Unusual Presentation

Uterine rupture is a rare life threatening emergency with severe obstetric consequences. Most ruptures occur in a scarred uterus at the site of previous transmyometrial surgical incision. However, rupture on site distant from previous scar is a very rare entity. It is associated with major maternal and neonatal morbidity than rupture at a scarred area. Index case describes a scenario where uterine rupture occurred at the fundal region, far away from previous caesarean scar site leading to fetal demise. Till now, only a very few cases with uterine rupture away from the site of previous caesarean scar have been reported. Keywords: uterine rupture, unscarred uterus, acute abdomen, hemoperitoneum

A case of placenta increta in placenta previa: a rare case report

Placenta increta, one type of morbidly adherent placenta, is characterized by entire or partial absence of the decidua basalis, and by the incomplete development of the fibrinoid or Nitabuch’s layer and villi actually invading the myometrium. When the internal os is covered partially or completely by placenta, it is described as a placenta previa. Simultaneously these two complications occurring in a post LSCS scarred uterus is a very rare scenario and anticipated frequently to cause catastrophic obstetric outcome. A 32-years-old woman of second gravida, para 1, with previous history of LSCS 7 years back, with living issue one, admitted in our hospital at 35 weeks 5 days gestation with asymptomatic placenta previa with placenta increta. The case was diagnosed effectively by ultrasonography. Intra-operatively, compression sutures and bilateral uterine artery ligature was tried to control hemorrhage which were failed and a quick decision of caesarean hysterectomy was done. Preserving both ovaries, total hysterectomy was the only option to save the mother in our case. Other options attempting to preserve uterus could have ended up with grave consequences in this case. This was a very rare case of asymptomatic placenta previa with placenta increta in a post LSCS scarred uterus and it was successfully managed by judicious caesarean hysterectomy.

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.

An Exceptional Case of Uterine Rupture on a Scarred Uterus Discovered Following a Late Abortion

Uterine rupture (UR) is a life-threatening peripartum complication with a high incidence of maternal morbidity and mortality. It is quite common in the third trimester of pregnancy ranging from 1 / 8,000 to 1 / 15,000 pregnancies. Its true incidence in the first trimester is unknown as most of the reports are case reports or small series of cases. We report an exceptional case of uterine rupture at 13 weeks of amenorrhea in a 34-year-old patient with a history of a cesarean delivery 2 years ago, discovered following a late abortion due to persistent bleeding and failure of aspiration. Through this observation we would like to draw the attention of practitioners to this diagnosis, which is often overlooked in the first trimester.