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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 75-77

Spontaneous rupture of an unscarred uterus in a multipara at 32 weeks of gestation: A case report


1 Department of Obstetrics and Gynaecology, Barau Dikko Teaching Hospital, College of Medical Sciences, Kaduna State University, Tafawa Balewa Road, Kabala Coastain, Kaduna, Nigeria
2 Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria

Date of Web Publication30-May-2019

Correspondence Address:
Dr. Caleb Mohammed
Department of Obstetrics and Gynaecology, Barau Dikko Teaching Hospital, College of Medical Sciences, Kaduna State University, Tafawa Balewa Road, Kabala Coastain, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ais.ais_5_19

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  Abstract 


Uterine rupture is still a public health problem in developing countries. Most spontaneous uterine rupture in this region occurs in unscarred uterus due to prolonged obstructed labor and injudicious use of oxytocics. Antepartum uterine rupture is uncommon; the diagnosis is not always obvious; and maternal, fetal morbidity and mortality are high. A 30-year-old gravida 7 para 5 +1 2alive, at 32 weeks of gestation, booked in a primary healthcare center and presented with sudden onset abdominal pain and vaginal bleeding of 4-h duration. Ultrasound scan revealed a major degree placenta previa; however, intraoperatively an anterior uterine rupture was detected with a fresh still-born male fetus weighing 1,650 g with intact membranes within the abdominal cavity. She had a subtotal hysterectomy performed. This case highlights the occurrence of spontaneous uterine rupture in an unscarred uterus; increased awareness on the need for early presentation enables prompt diagnosis and treatment.

Keywords: Spontaneous rupture, subtotal hysterectomy, unscarred uterus


How to cite this article:
Mohammed C, Adze JA, Bature SB, Amina MD, Matthew TC, Amina A, Musa J. Spontaneous rupture of an unscarred uterus in a multipara at 32 weeks of gestation: A case report. Arch Int Surg 2018;8:75-7

How to cite this URL:
Mohammed C, Adze JA, Bature SB, Amina MD, Matthew TC, Amina A, Musa J. Spontaneous rupture of an unscarred uterus in a multipara at 32 weeks of gestation: A case report. Arch Int Surg [serial online] 2018 [cited 2019 Aug 24];8:75-7. Available from: http://www.archintsurg.org/text.asp?2018/8/2/75/259465




  Introduction Top


Rupture of a pregnant uterus is one of the life-threatening complications seen in obstetric practice.[1] It is a rare complication in developed countries but is still one of the causes of maternal and perinatal morbidity and mortality in African countries.[2] Antepartum uterine rupture can occur in an unscarred uterus but is a rare event. We report a case of a spontaneous rupture of an unscarred gravid uterus at 32-week gestation.


  Case Report Top


A 30-year-old gravida 7 para 5 +1 2alive, at 32 weeks of gestation, presented to our labur ward with sudden onset of abdominal pain and vaginal bleeding of 18-h duration. She had minimal vaginal bleeding a week prior to presentation. The pregnancy was booked at a primary healthcare center and number of visits was not ascertained; however, they were said to be uneventful. She had five previous pregnancies that ended spontaneously by vaginal delivery and the sixth pregnancy resulted in a complete miscarriage at 12 weeks. She had no previous uterine scar. She attained menarche at the age of 15 and menstruated for 4 days with a cycle length of 30 days.

On examination, she was in intermittent painful distress, not pale and anicteric. Her chest was clinically clear and pulse rate was 90 beats/min with blood pressure of 120/80 mmHg. Abdominal examination revealed a uniformly enlarged abdomen, with diffuse tenderness. Fetal lie and presentation were not determined due to tenderness. Abdomen ultrasound scan (USS) showed singleton fetus without cardiac activity and placenta covering the cervical os, estimated gestational age was 32 weeks.

Investigations done revealed hematocrit of 30%; her serum electrolytes, and urea and creatinine levels were essentially normal. A diagnosis of major degree placenta previa was made. The patient was counseled and prepared for a Cesarean section; however, intraoperatively, a fetus with an intact amniotic sac, placenta attached to it, was found in the abdominal cavity [Figure 1]a and [Figure 1]b; further inspection showed an anterior longitudinal uterine rupture in the body of the uterus [Figure 2]a and [Figure 2]b. A fresh still-born male fetus weighing 1,650 g was delivered [Figure 3]a and [Figure 3]b. She had a subtotal hysterectomy. She did well and was discharged on the seventh postoperative day. She was seen subsequently in the clinic with no complaints.
Figure 1: (a) Placenta. (b) Foetus within the amniotic sac and placenta outside

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Figure 2: (a and b) Uterine rupture

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Figure 3: (a) Foetus within the amniotic sac. (b) Foetus after amniorexis

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  Discussion Top


Rupture of an unscarred uterus is a rare event. The estimated incidence of spontaneous rupture of unscarred uteri in developed countries is 12/100,000 pregnancies.[3] In such cases, rupture may be either traumatic or spontaneous. The frequency is often higher in developing countries, where it can reach 75% of cases in some areas.[4] Diagnosis of rupture of an unscarred uterus antepartum is often delayed and clinical signs are nonspecific and can be confusing. Indeed, it is not always easy to distinguish it with other abdominal emergencies (appendicitis, gallstones, pancreatitis, etc.).[2],[5],[6] High parity is recognized as a major risk factor of spontaneous uterine rupture in unscarred uterus.[6] Other etiological factors classically recognized as contributing to a rupture of unscarred uterus are as follows: obstetric maneuvers, malpresentations especially transverse fetal position, cephalopelvic disproportion, excessive uterine contractions, abnormal placentation (placenta percreta mainly), trauma due to uterine curettage, and uterine abnormalities.[4],[7] In some cases, the rupture of gravid uterus has no obvious cause. Besides multiparity, no apparent cause was found in this patient. In his series of 40 uterine ruptures, Schrinsky and Benson[8] found 10 spontaneous ruptures without any predisposing factors.

Early surgical intervention is usually the key to successful treatment of uterine rupture.[2],[6] The therapeutic management includes a total or subtotal hysterectomy; uterine repair can be performed as well in patients to preserve their reproductive function.[2] Our patient had a subtotal hysterectomy because of her parity. The risk recurrence of rupture assessed to be between 4% and 19% at a subsequent pregnancy.[2],[4] For this reason, it has been recommended that women with a previous uterine rupture undergo an elective Cesarean delivery as soon as fetal lung maturity can be demonstrated.[9] Uterine rupture of an unscarred uterus is associated with significant morbidity and mortality. Schrinsky and Benson,[8] in their study, found a maternal and fetal mortality rate of 20.8% and 64.6%, respectively. This patient presented had a good postoperative outcome though she lost her baby.[2]


  Conclusion Top


Rupture of an unscarred uterus is a rare and potentially catastrophic event. Increased awareness on the need for early presentation may enable prompt diagnosis and treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tola EN. First trimester Spontaneous uterine rupture in a young woman with uterine anomaly, Case Rep Obstet Gynecol 2014;2014:967386.  Back to cited text no. 1
    
2.
Gueye M, Nbaye M, Ndiaye-Gueye MD, Kane-Guèye SM, Diouf AA, Niang MM, et al. Spontaneous uterine rupture of an unscarred uterus before labour. Case Rep Obstet Gynecol 2012;2012:598356.  Back to cited text no. 2
    
3.
Kaur J, Goel B, Sehgal A. Rupture uterus following blunt trauma at 16 weeks gestation. Int J Reprod Contracept Obstet Gynecol 2012;1:64-6.  Back to cited text no. 3
    
4.
Ahmadi S, Nouira M, Bibi M, Boughuizane S, Saidi H, Chaib A, et al. Uterine rupture of the unscarred uterus. About 28 cases. Gynecol Obstet Fertil 2003;31:713-7.  Back to cited text no. 4
    
5.
Misra M, Roychowdhury R, Sarkar NC, Koley MM. The spontaneous prelabour rupture of an unscarred uterus at 34 weeks of pregnancy. J ClinDiagn Res 2013;7:548-9.  Back to cited text no. 5
    
6.
Suner S, Jagminas L, Peipert JH, Linakis J. Fatal spontaneous rupture of a gravid uterus: Case report and literaturereview of uterine rupture. J Emerg Med 1996;14:181-5.  Back to cited text no. 6
    
7.
Leung F, Courtois L, Aouar Z, Bourtembourg A, Eckman A, Terzibachian A, et al. Spontaneous Rupture of the Unscarred Uterus During Labor: Case Report. Gynecol Obstet Fertil 2009;37:342-5.  Back to cited text no. 7
    
8.
Schrinsky DC, Benson RC. Rupture of the pregnantuterus: A review. Obstet Gynecol Surv 1978;33:217-32.  Back to cited text no. 8
    
9.
Conturso R, Redaelli L, Pasini A, Tenore A. Spontaneous uterine rupture with amniotic sac protrusion at 28 weeks subsequent to previous hysteroscopic metroplasty. Eur J Obstet Gynecol Reprod Biol 2003;107:98-100.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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