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Posterior uterine wall rupture of an unscarred gravid uterus at 37 weeks of gestation: Experience of a rare case with a review of the literature

Michail Varras, Akrivis Christodoulos

Am J Case Rep 2010; 11:20-23

ID: 878330

Background: Uterine perforation is an uncommon but serious and life-threatening event, and the diagnosis is difficult in an unscarred gravid uterus.
Case Report: A 44-year-old woman, gravida 5, para 2, with a history of two first-trimester elective suction abortions, presented at the 37th week of her gestation with spontaneous rupture of membranes. During labor induction with intravenous oxytocin using a standard protocol, the woman complained of sudden abdominal pain and profound fetal bradycardia occurred. During an emergency laparotomy, free blood in the abdomen was found and the fetus and the placenta were completely exteriorized from the uterus. A stillborn male infant weighing 3400 g was removed from the abdomen. The placenta was removed manually from the abdomen and the free blood was irrigated. The uterus was exteriorized for examination and a 7-cm longitudinal defect at the posterior surface of the uterus from the fundus to the supracervical area was identified as the source of the rupture. A hysterectomy was performed because hemostasis was not achieved.
Conclusions: Spontaneous uterine rupture is a rare but serious and catastrophic event. Sudden abdominal pain and fetal distress during active labor in association with multigravidity should always prompt consideration of uterine rupture as a possible cause in cases of unexplained anomalies in an unscarred gravid uterus. A history of possible myometrial damage should be taken in consideration as well.

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