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Early Diagnosis of Impending Rupture Uterus During U/S: A Case Report Publisher



Parviz S1 ; Deldar Pasikhani M3 ; Khazardoost S2 ; Malek M1 ; Zamani N4
Authors
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Authors Affiliations
  1. 1. Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Radiology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
  2. 2. Department of perinatology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
  4. 4. Department of Gynecologic Oncology, Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran

Source: International Journal of Surgery Case Reports Published:2024


Abstract

Introduction and importance: Uterine rupture is a rare condition that typically occurs in a scarred uterus and can happen during late pregnancy, labor, or the early postpartum period. Since most cases are seen in patients with a history of cesarean surgery, the anterior lower uterine segment is the most affected area. Most patients present with acute symptoms that compromise the fetus and the mother in a life-threatening manner. Case presentation: We present a case of uterine rupture with subacute symptoms occurring in the second trimester, which is extremely rare. The patient was a stable second-trimester multiparous woman with chronic abdominal pain, but without any signs of peritoneal bleeding or instability. No history of previous cesarean section was present, and she had recently undergone a non-complicated hysteroscopic polypectomy. Transabdominal and transvaginal ultrasounds were performed, revealing a significant full-thickness myometrial defect in the posterior uterine lower segment. This defect allowed the amniotic sac to protrude into the posterior cul-de-sac. No abdominopelvic hematoma was detected. These findings were confirmed in an urgent MRI, and the patient underwent a laparotomy during which a significant full-thickness defect was discovered at the posterior of the uterus. As it was impossible to continue the pregnancy, the fetus was surgically removed and then prepared using multiple layers. Clinical discussion: The difference between our case and the previously reported one is in the aspect of gradual stable presentation and lacks of vaginal bleeding. Conclusion: Previous hysteroscopy carries a risk for future pregnancy complications, such as uterine rupture. © 2024 The Authors