Uterus rüptürü gelişen 3 olguda konservatif tedavi ve sonuçları ile birlikte literatür derlemesi

Öz

2019-2021 Yılları arasında hastanemizde konservatif olarak tedavi edilen 3 uterus rüptürü olgusu sunulacaktır. Olgu 1 29 yaşında 5. Gebeliği olup daha önce 3 sezaryen öyküsü mevcuttur. Olgu 2 27 yaşında 4. Gebeliği olup daha önce 2 sezaryen öyküsü mevcuttur. Olgu 3 22 yaşında olup daha önce 1 sezaryen öyküsü mevcuttur. Her üç olgu komplet uterin rüptür meydana gelmiştir. Her üç olguda bebek batından çıkarılmıştır. 3 bebek canlı doğurtulmuş fakat bir bebek başka bir merkeze sevk edildikten sonra ex olmuştur. Anne ölümü olmamıştır. Olgu 1 hasta aile baskısı ile evde doğum denemiştir. Olgu 2 EDT nedeniyle takip edilirken aniden rüptür olmuştur. Olgu 3 hastaneye geldiği anda rüptür saptanmıştır. Olgu 1’ de ayrıca uterin rüptüre mesane rüptürüde eşlik etmektedir. Her üç olguya bilateral uterin arter ligasyonu, bilateral ovaryen arter ligasyonu, retroperitona ilerleyen hematomun stabillenmesi, primer uterin onarım ve peritonizasyon işlemleri yapılmıştır. Olgu 1’ de gelişen mesane hasarı primer onarılmış fakat sonrasında kaçak olması üzerine tekrar opere edilmiştir. Olgu 1’ de atoni olması üzerine uterin balon tamponad konulmuştur. Her üç olguda uterus korunmuş ve hastalar sağlıklı bir şekilde taburcu edilmiştir.

Anahtar Kelimeler

• Uterus Rüptürü
• Sezaryen
• Gebelikte Kanama
• Obstetrik Acil

A literature review with conservative treatment and results in 3 cases of uterine rupture

Öz

Three cases of uterine rupture conservatively treated in our hospital between 2019-2021 will be presented. Case 1 is 29 years old and has 5th pregnancy and has 3 previous cesarean sections. Case 2 is 27 years old and has 4th pregnancy. She has a history of 2 previous cesarean sections. Case 3 is 22 years old and has a previous cesarean section history. Complete uterine rupture occurred in all three cases. The baby was removed from the abdomen in all three cases. 3 babies were delivered live but one baby died after being transferred to another center. No maternal death occurred. Case 1 patient tried home delivery under family pressure. Case 2 suddenly ruptured while being followed up for EDT. Rupture was detected as soon as case 3 came to the hospital. In Case 1, uterine rupture is also accompanied by rupture of the bladder. Bilateral uterine artery ligation, bilateral ovarian artery ligation, stabilization of hematoma progressing to the retroperitoneum, primary uterine repair and peritonization procedures were performed in all three cases. The bladder damage that developed in Case 1 was primarily repaired, but it was re-operated due to leakage. In case 1, uterine balloon was placed due to atony. In all three cases, the uterus was preserved and the patients were discharged in good health.

Anahtar Kelimeler

• Uterine Rupture
• Cesarean Section
• Bleeding During Pregnancy
• Obstetrics Emergency

Kaynakça

1. 1. Spaulding LB, Gallup DG. Current concepts of management of rupture of the gravid uterus. Obstet Gynecol. 1979 Oct;54(4):437-41. PMID: 492622.
2. 2. Miller DA Goodwin TM, Gherman RB, Paul RH. Intrapartum rupture of the unscarred uterus. Obstet Gynecol. 1997 May;89(5 Pt 1):671-3. doi: 10.1016/s0029-7844(97)00073-2. PMID: 9166298.
3. 3. Gardeil F, Daly S, Turner MJ. Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol. 1994 Aug;56(2):107-10. doi: 10.1016/0028-2243(94)90265-8. PMID: 7805960.
4. 4. Lao TT, Leung BFH. Rupture of the gravid uterus. Eur J Obstet Gynecol Reprod Biol 1987; 25: 175-180.
5. 5. Golan A, Sandbank O, Rubin A. Rupture of the pregnant uterus. Obstet Gynecol. 1980 Nov;56(5):549-54. PMID: 7432723.
6. 6. Chen LH, Tan KH, Yeo GS. Modern obstetrik uygulamada uterus rüptürünün on yıllık bir incelemesi. Ann Acad Med Sinap. 1995 Kasım;24(6):830-5. PMID: 8838990.
7. 7. Norman JE. Uterine rupture during therapeutic abortion in the second trimester using mifepristone and prostaglandin. Br J Obstet Gynaecol. 1995 Apr;102(4):332-3. doi: 10.1111/j.1471-0528.1995.tb09142.x. PMID: 7612519.
8. 8. Gurudut KS, Gouda HS, Aramani SC, Patil RH. Spontaneous rupture of unscarred gravid uterus. J Forensic Sci. 2011 Jan;56 Suppl 1:S263-5. doi: 10.1111/j.1556-4029.2010.01622.x. Epub 2010 Nov 29. PMID: 21114667.

9. 9. Kieser KE, Baskett TF. A 10-year population-based study of uterine rupture. Obstet Gynecol. 2002 Oct;100(4):749-53. doi: 10.1016/s0029-7844(02)02161-0. PMID: 12383544.
10. 10. Pelosi MA 3rd, Pelosi MA. Spontaneous uterine rupture at thirty-three weeks subsequent to previous superficial laparoscopic myomectomy. Am J Obstet Gynecol. 1997 Dec;177(6):1547-9. doi: 10.1016/s0002-9378(97)70110-8. PMID: 9423770.
11. 11. Pan HS, Huang LW, Hwang JL, Lee CY, Tsai YL, Cheng WC. Uterine rupture in an unscarred uterus after application of fundal pressure. A case report. J Reprod Med. 2002 Dec;47(12):1044-6. PMID: 12516327.
12. 12. Flamm BL. Once a cesarean, always a controversy. Obstet Gynecol. 1997 Aug;90(2):312-5. doi: 10.1016/S0029-7844(97)00263-9. PMID: 9241315.
13. 13. American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2007) Guidelines for Perinatal Care, 6th ed.
14. 14. Sheldon CP. A record of 26 cases of rupture of the uterus. Am J Obstet Gynecol 1936; 31: 455-466.
15. 15. Pedowitz P, Perell A. Rupture of the uterus. Am J Obstet Gynecol 1958; 76: 161-171.
16. 16. Agüero O, Kizer S. Obstetric prognosis of the repair of uterine rupture. Surg Gynecol Obstet. 1968 Sep;127(3):528-30. PMID: 5663821.
17. 17. Decherney AH., Goodwin, TM., Nathan, L., Laufer, N. (Eds). Current Diagnosis &Treatment Obstetrics &Gynecology. Tenth Edition 2010. Current Diagnosis & Treatment Series., Lange . McGraw Hill, USA.
18. 18. O'Leary JL, O'Leary JA. Uterine artery ligation in the control of intractable postpartum hemorrhage. Am J Obstet Gynecol. 1966 Apr 1;94(7):920-4. doi: 10.1016/0002-9378(66)90026-3. PMID: 5295587.
19. 19. Jacobs,AI. Management of postpartum hemorrhage at cesarean delivery. In: UpToDate Lockwood,CJ (Ed),UpToDate, Waltham, MA, 2012.
20. 20. O'Leary JA. Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med. 1995 Mar;40(3):189-93. PMID: 7776302.
21. 21. AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol. 1994 Sep;171(3):694-700. doi: 10.1016/0002-9378(94)90084-1. PMID: 8092217.
22. 22. Sentilhes L, Trichot C, Resch B, Sergent F, Roman H, Marpeau L ark.Fertility and pregnancy outcomes following uterine devascularization for severe postpartum haemorrhage. Hum Reprod. 2008 May;23(5):1087-92. doi: 10.1093/humrep/den049. Epub 2008 Mar 5. PMID: 18321892.
23. 23. Roman H, Sentilhes L, Cingotti M, Verspyck E, Marpeau L. Uterine devascularization and subsequent major intrauterine synechiae and ovarian failure. Fertil Steril. 2005 Mar;83(3):755-7. doi: 10.1016/j.fertnstert.2004.07.975. PMID: 15749510.
24. 24. Toğrul C. , Başer E. , Özdal B. , Güngör T. Postpartum kanamanın yönetimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2012; 9(36): 1502-1508.