A case with unscarred uterus rupture during late postpartum period

Abstract

An unscarred uterus rupture is uncommon. It has non-specific symptoms and presentation differs according to the site and time of rupture. It is usually diagnosed intrapartum or shortly after delivery. Here we report a spontaneous rupture of unscarred uterus with delayed presentation and without any usual risk factors. A 33-year-old and 38 weeks pregnant woman presented with regular uterine contractions. The labor was successfully completed vaginally without any augmentation and no intrapartum complications were observed. After 72 hours the patient complained of an abdominal distension and tenderness. She underwent emergency explorative operation. Intraoperative examination revealed a rupture area on the right posterolateral wall of the uterine fundus approximately 5-6 cm in width. The post-operative period was uneventful and the patient was discharged on 5^th postoperative day. Spontaneous rupture of unscarred uterus should be kept in mind even though it is rarely seen complication at late postpartum period. 

Keywords

• postpartum rupture,Uterine rupture,postpartum hemorrhage

References

1. [1] Turner MJ. Uterine rupture. Best Pract Res Clin Obstet Gynaecol 2002;16:69-79.
2. [2] Siddiqui M, Ranasinghe JS. Spontaneous rupture of uterus. J Clin Anesth 2002;14:368-70.
3. [3] Smith JG, Mertz HL, Merril DC. Identifying risk factors for uterine rupture. Clin Perinatol 2008;35:85-99.
4. [4] Mazzone ME, Woolever J. Uterine rupture in a patient with an unscarred uterus: a case study. WMJ 2006;105:64-6.
5. [5] Hofmeyr GJ, Say L, Gulmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG 2005;112:1221-8.
6. [6] Nelson JP. Posterior uterine rupture secondary to use of herbs leading to peritonitis and maternal death in a primigravida following vaginal delivery of a live baby in western Uganda: a case report. Pan Afr Med J 2016;23:81.
7. [7] Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG 2009;116:1069-80.
8. [8] Langton J, Fishwick K, Kumar B, Nwosu EC. Spontaneous rupture of an unscarred gravid uterus at 32 weeks gestation. Hum Reprod 1997;12:2066-7.

9. [9] Ripley DL. Uterine emergencies. Obstet Gynecol Clin North Am 1999;26:419-34.