Cargando…

A case of traumatic uterine avulsion in pregnancy

Complete uterine avulsion is an extremely rare complication of trauma sustained during pregnancy. We present the case of a 21-year-old nullipara at 16 weeks' gestation who was involved in a high-speed motor vehicle collision with subsequent fetal demise. Initially she was hemodynamically stable...

Descripción completa

Detalles Bibliográficos
Autores principales: Chambers, M.E., Nguyen Pham, A.B., Milone, G.F., Licon, E., Bakhta, Y.A., Chan, K.K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495616/
https://www.ncbi.nlm.nih.gov/pubmed/37705926
http://dx.doi.org/10.1016/j.tcr.2023.100920
_version_ 1785104936854355968
author Chambers, M.E.
Nguyen Pham, A.B.
Milone, G.F.
Licon, E.
Bakhta, Y.A.
Chan, K.K.
author_facet Chambers, M.E.
Nguyen Pham, A.B.
Milone, G.F.
Licon, E.
Bakhta, Y.A.
Chan, K.K.
author_sort Chambers, M.E.
collection PubMed
description Complete uterine avulsion is an extremely rare complication of trauma sustained during pregnancy. We present the case of a 21-year-old nullipara at 16 weeks' gestation who was involved in a high-speed motor vehicle collision with subsequent fetal demise. Initially she was hemodynamically stable and demonstrated small amounts of intraabdominal free fluid, therefore multidisciplinary conservative measures were undertaken. However, as her condition worsened, she was taken for exploratory laparotomy, revealing complete gravid uterine avulsion at the level of the cervicoisthmic junction. Due to hemodynamic instability and concerns for retroperitoneal bleeding, a supracervical hysterectomy was performed. Although a rare occurrence, our case demonstrates the need for a high level of suspicion for uterine avulsion in certain cases of trauma in pregnancy. This highlights the false reassurance provided by stable vitals in a pregnant patient that may mask ongoing bleeding and development of hemorrhagic shock, the importance of interpreting different imaging modalities together when the cause of instability is unclear, and the utility of a multidisciplinary approach. While our patient underwent hysterectomy due to hemodynamic instability, it is unknown whether earlier investigation with laparoscopy to confirm uterine integrity may have circumvented this and allowed for fertility-sparing management. As such, our case encourages the utilization of early diagnostic laparoscopy if there is concern for uterine avulsion for the consideration of alternative surgical interventions for management.
format Online
Article
Text
id pubmed-10495616
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-104956162023-09-13 A case of traumatic uterine avulsion in pregnancy Chambers, M.E. Nguyen Pham, A.B. Milone, G.F. Licon, E. Bakhta, Y.A. Chan, K.K. Trauma Case Rep Case Report Complete uterine avulsion is an extremely rare complication of trauma sustained during pregnancy. We present the case of a 21-year-old nullipara at 16 weeks' gestation who was involved in a high-speed motor vehicle collision with subsequent fetal demise. Initially she was hemodynamically stable and demonstrated small amounts of intraabdominal free fluid, therefore multidisciplinary conservative measures were undertaken. However, as her condition worsened, she was taken for exploratory laparotomy, revealing complete gravid uterine avulsion at the level of the cervicoisthmic junction. Due to hemodynamic instability and concerns for retroperitoneal bleeding, a supracervical hysterectomy was performed. Although a rare occurrence, our case demonstrates the need for a high level of suspicion for uterine avulsion in certain cases of trauma in pregnancy. This highlights the false reassurance provided by stable vitals in a pregnant patient that may mask ongoing bleeding and development of hemorrhagic shock, the importance of interpreting different imaging modalities together when the cause of instability is unclear, and the utility of a multidisciplinary approach. While our patient underwent hysterectomy due to hemodynamic instability, it is unknown whether earlier investigation with laparoscopy to confirm uterine integrity may have circumvented this and allowed for fertility-sparing management. As such, our case encourages the utilization of early diagnostic laparoscopy if there is concern for uterine avulsion for the consideration of alternative surgical interventions for management. Elsevier 2023-08-21 /pmc/articles/PMC10495616/ /pubmed/37705926 http://dx.doi.org/10.1016/j.tcr.2023.100920 Text en https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Chambers, M.E.
Nguyen Pham, A.B.
Milone, G.F.
Licon, E.
Bakhta, Y.A.
Chan, K.K.
A case of traumatic uterine avulsion in pregnancy
title A case of traumatic uterine avulsion in pregnancy
title_full A case of traumatic uterine avulsion in pregnancy
title_fullStr A case of traumatic uterine avulsion in pregnancy
title_full_unstemmed A case of traumatic uterine avulsion in pregnancy
title_short A case of traumatic uterine avulsion in pregnancy
title_sort case of traumatic uterine avulsion in pregnancy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495616/
https://www.ncbi.nlm.nih.gov/pubmed/37705926
http://dx.doi.org/10.1016/j.tcr.2023.100920
work_keys_str_mv AT chambersme acaseoftraumaticuterineavulsioninpregnancy
AT nguyenphamab acaseoftraumaticuterineavulsioninpregnancy
AT milonegf acaseoftraumaticuterineavulsioninpregnancy
AT licone acaseoftraumaticuterineavulsioninpregnancy
AT bakhtaya acaseoftraumaticuterineavulsioninpregnancy
AT chankk acaseoftraumaticuterineavulsioninpregnancy
AT chambersme caseoftraumaticuterineavulsioninpregnancy
AT nguyenphamab caseoftraumaticuterineavulsioninpregnancy
AT milonegf caseoftraumaticuterineavulsioninpregnancy
AT licone caseoftraumaticuterineavulsioninpregnancy
AT bakhtaya caseoftraumaticuterineavulsioninpregnancy
AT chankk caseoftraumaticuterineavulsioninpregnancy