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Sezeryan Sonrası Vaginal Doğumu Takiben Oluşan Uterus Rüptürü: Gecikmiş Vakalardaki BT Bulguları ve Klinik Seyir

Year 2020, Volume: 17 Issue: 4, 519 - 523, 31.12.2020
https://doi.org/10.38136/jgon.786748

Abstract

Amaç: Sezeryan sonrası vajinal doğum (SSVD) nedeniyle oluşan ve kliniğe geç başvuru yapan antenatal takibi olmayan uterus rüptür (UR)’lü hastalardaki intraabdominal komplikasyonların tanısında bilgisayarlı tomografi (BT)’nin etkinliği, hastaların tedavi yönetimi ve klinik seyirlerinin tartışılması amaçlandı.
Gereçler ve Yöntem: Temmuz 2015 ile Şubat 2020 tarihleri arasında, Somali Mogadişu Recep Tayyip Erdoğan Eğitim ve Araştırma hastanesi’ndeki 5820 doğum arasından UR gelişen 21 hasta incelendi. Sezeryan öyküsü olmayanlar, semptom olmaksızın uterus skarının ayrıştığı hastalar ve gestasyonel yaşı <28 hafta olanlar çalışma dışı bırakıldı. Hastaların klinik ve laboratuvar verileri, torakoabdominal BT’leri elektronik kayıtlardan retrospektif olarak değerlendirildi.
Bulgular: Çalışmaya dahil edilen 15 hastanın ortalama maternal yaşı 25.06 ± 5.46 (18-32 aralığında) yıl idi. Hastaların 9 (%60)’unda bir ve 6 (%40)’sında iki sezeryan öyküsü mevcuttu. İki doğum arasındaki süre ortalama 14.57 ± 3.35 (11-19 aralığında) ay idi. Hastaların hiçbirisinde antenatal takip yoktu. Fetal ve maternal mortalite gelişen 2 (%13.3) hastada fetüsün peritoneal kaviteye doğduğu tespit edildi. Vajinal doğumu takiben hastaneye başvuru süreleri ortalama 16.6 ± 1.99 gün idi. Postoperatif yoğun bakıma alınan 8 (%53.3) hastanın yoğun bakımda yatış süresi 2.26 ± 3.10 (2-8 aralığında) gün ve tüm hastaların hastanede yatış süresi ortalama 13.13 ± 4.13 gün idi. 8 (%53.3) hastaya total abdominal histerektomi yapıldı. 13 (%86.6) hastanın mevcut BT’lerinde sırasıyla uterus duvar defekti ve peritonit (n=13; %100), intraabdominal apse (n=11; %84.6), asit (n=10; %76.9), uterin kavitede hava, paralitik ileus ve pnomoni (n=8; %61.5), plevral effüzyon (n= 5; %38.4) ve splenik enfarkt (n=1; %7.6) mevcuttu.
Sonuç: Somali gibi gelişmemiş ülkelerde antenatal takibi olmayan gebe prevalansı yüksektir. Özellikle SSVD planlananlarda doğum öncesi antenatal takibin erken başlatılması ve donanımlı merkezlerde bu işlemin yapılması gerekmektedir. Ayrıca gecikmiş UR’li hastalarda oluşan komplikasyonların değerlendirilmesi, doğru tanı ve tedavi yönetimi açısından hastalara hızlı ve güvenilir olan BT yapılması gerekliliğine inanıyoruz.

References

  • 1. Holmgren CM. Uterine Rupture Associated With VBAC. 2012;55(4):978–87.
  • 2. Has R, Topuz S, Kalelioglu I, Tagrikulu D. Imaging features of postpartum uterine rupture: A case report. Abdom Imaging. 2008;33(1):101–3.
  • 3. Rodgers SK, Kirby CL, Smith RJ, Horrow MM. Imaging after cesarean delivery: Acute and chronic complications. Radiographics. 2012;32(6):1693–712.
  • 4. Zeteroglu S, Ustun Y, Engin-Ustun Y, Sahin HG, Kamaci M. Eight years’ experience of uterine rupture cases. J Obstet Gynaecol (Lahore). 2005;25(5):458–61.
  • 5. Madaan M, Agrawal S, Nigam A, Aggarwal R, Trivedi SS. Trial of labour after previous caesarean section : The predictive factors affecting outcome. 2011;31(April):224–8.
  • 6. Motomura K, Ganchimeg T, Nagata C, Ota E. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health. Nat Publ Gr. 2017;(November 2016):1–9.
  • 7. Ponder KL, Won R, Clymer L. Uterine Rupture on MRI Presenting as Nonspecific Abdominal Pain in a Primigravid Patient with 28-Week Twins Resulting in Normal Neurodevelopmental Outcomes at Age Two. Case Rep Obstet Gynecol. 2019; 2019:1–5
  • 8. Gui B, Carducci B, Bonomo L. normal and abnormal acute findings. 2016;(February):534–41.
  • 9. Ali MB, Ali MB. Late Presentation of Uterine Rupture: A Case Report. 2019;11(10).
  • 10. El-Kehdy G, Ghanem J, El-Rahi C, Nakad T. Rupture of uterine scar 3 weeks after vaginal birth after cesarean section (VBAC). J Matern Neonatal Med. 2006;19(6):371–3.
  • 11. Gallot D, Delabaere A, Desvignes F, Vago C, Accoceberry M, Lémery D. Quelles sont les recommandations d’organisation et d’information en cas de proposition de tentative de voie basse pour utérus cicatriciel. J Gynecol Obstet Biol la Reprod. 2012;41(8):782–7.

Uterine Rupture Following Vaginal Birth After Caesarean Section (VBAC): CT Findings and Clinical Course in Delayed Cases

Year 2020, Volume: 17 Issue: 4, 519 - 523, 31.12.2020
https://doi.org/10.38136/jgon.786748

Abstract

Aim: This research was aimed the show of the effectiveness of computed tomography (CT) in the diagnosis of intraabdominal complications in patients with uterine rupture (UR) due to vaginal birth after caesarean section (VBAC) and admitted to the clinic late. It was aimed to discuss the treatment management and clinical course of patients.
Materials and Method: Between July 2015 and February 2020, 21 patients who developed UR among 5820 births in the Mogadishu Recep Tayyip Erdogan Hospital in Somalia were examined. Those without a history of caesarean section, patients with uterine scar dehiscence without symptoms, and gestational age <28 weeks were excluded. Clinical and laboratory data and thoracoabdominal CTs of the patients were evaluated retrospectively from electronic records.
Results
The mean maternal age of 15 patients included in the study was 25.06±5.46 (range 18-32) years. There were one caesarean history in 9 (60%) patients and two caesarean section history in 6 (40%) patients. The mean time between two births was 14.57±3.35 (range 11-19) months. None of the patients had antenatal care (ANC) follow-up. In 2 (13.3%) patients who developed fetal and maternal mortality, it was determined that the fetus was born into the peritoneal cavity in these 2 patients. The mean duration of admission to the hospital after vaginal delivery was 16.6±1.99 days. The hospitalization period of 8 (53.3%) patients admitted to the postoperative intensive care unit was 2.26±3.10 (in the range of 2-8) days, and the mean hospitalization time of all patients was 13.13±4.13 days. 8 (53.3%) patients underwent total abdominal hysterectomy. In CTs of 13 (86.6%) patients, uterine wall defect and peritonitis detected in 13 of them (100%), intraabdominal abscess detected in 11 of them (84.6%), acid detected in 10 of them (76.9%), air in the uterine cavity, paralytic ileus and pneumonia detected in 8 of them (61.5%), pleural effusion detected in 5 of them (38.4%), and splenic infarction detected in 1 of them (7.6%).
Conclusion
The prevalence of pregnant women without ANC follow-up is high in underdeveloped countries such as Somalia. It is necessary to start antenatal follow-up early, especially in those who are planned VBAC, and this procedure should be done in equipped centers. Furthermore, we believe in the necessity of performing CT, which is fast and reliable for all patients, in terms of evaluating complications, finding correct diagnosis, and treatment management in patients with delayed UR.

References

  • 1. Holmgren CM. Uterine Rupture Associated With VBAC. 2012;55(4):978–87.
  • 2. Has R, Topuz S, Kalelioglu I, Tagrikulu D. Imaging features of postpartum uterine rupture: A case report. Abdom Imaging. 2008;33(1):101–3.
  • 3. Rodgers SK, Kirby CL, Smith RJ, Horrow MM. Imaging after cesarean delivery: Acute and chronic complications. Radiographics. 2012;32(6):1693–712.
  • 4. Zeteroglu S, Ustun Y, Engin-Ustun Y, Sahin HG, Kamaci M. Eight years’ experience of uterine rupture cases. J Obstet Gynaecol (Lahore). 2005;25(5):458–61.
  • 5. Madaan M, Agrawal S, Nigam A, Aggarwal R, Trivedi SS. Trial of labour after previous caesarean section : The predictive factors affecting outcome. 2011;31(April):224–8.
  • 6. Motomura K, Ganchimeg T, Nagata C, Ota E. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health. Nat Publ Gr. 2017;(November 2016):1–9.
  • 7. Ponder KL, Won R, Clymer L. Uterine Rupture on MRI Presenting as Nonspecific Abdominal Pain in a Primigravid Patient with 28-Week Twins Resulting in Normal Neurodevelopmental Outcomes at Age Two. Case Rep Obstet Gynecol. 2019; 2019:1–5
  • 8. Gui B, Carducci B, Bonomo L. normal and abnormal acute findings. 2016;(February):534–41.
  • 9. Ali MB, Ali MB. Late Presentation of Uterine Rupture: A Case Report. 2019;11(10).
  • 10. El-Kehdy G, Ghanem J, El-Rahi C, Nakad T. Rupture of uterine scar 3 weeks after vaginal birth after cesarean section (VBAC). J Matern Neonatal Med. 2006;19(6):371–3.
  • 11. Gallot D, Delabaere A, Desvignes F, Vago C, Accoceberry M, Lémery D. Quelles sont les recommandations d’organisation et d’information en cas de proposition de tentative de voie basse pour utérus cicatriciel. J Gynecol Obstet Biol la Reprod. 2012;41(8):782–7.
There are 11 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Özgür Şahin This is me 0000-0002-5443-5080

Mehmet Tahtabaşı 0000-0001-9668-8062

Publication Date December 31, 2020
Submission Date August 27, 2020
Acceptance Date September 30, 2020
Published in Issue Year 2020 Volume: 17 Issue: 4

Cite

Vancouver Şahin Ö, Tahtabaşı M. Uterine Rupture Following Vaginal Birth After Caesarean Section (VBAC): CT Findings and Clinical Course in Delayed Cases. JGON. 2020;17(4):519-23.