Cargando…

Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital

Hemoperitoneum as a result of uterine rupture in a previously unscarred uterus is a rare entity to encounter and a potentially life-threatening condition. Ruptures can occur in a scarred uterus either spontaneously, due to operative manipulations, or with the use of uterotonic medications. In an uns...

Descripción completa

Detalles Bibliográficos
Autores principales: Tayade, Surekha, Chadha, Arzoo, Khandelwal, Smriti, Makhija, Nidhi, Tilva, Hard, Madaan, Sparsh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826621/
https://www.ncbi.nlm.nih.gov/pubmed/35165541
http://dx.doi.org/10.7759/cureus.21076
_version_ 1784647464400191488
author Tayade, Surekha
Chadha, Arzoo
Khandelwal, Smriti
Makhija, Nidhi
Tilva, Hard
Madaan, Sparsh
author_facet Tayade, Surekha
Chadha, Arzoo
Khandelwal, Smriti
Makhija, Nidhi
Tilva, Hard
Madaan, Sparsh
author_sort Tayade, Surekha
collection PubMed
description Hemoperitoneum as a result of uterine rupture in a previously unscarred uterus is a rare entity to encounter and a potentially life-threatening condition. Ruptures can occur in a scarred uterus either spontaneously, due to operative manipulations, or with the use of uterotonic medications. In an unscarred uterus, spontaneous ruptures are known with high parity, use of oxytocin, and prolonged, neglected labor. Ruptures can be silent with no symptoms resulting in a delay in diagnosis and a near-miss situation. Here, we report the case of a 25-year-old young female who was referred to our tertiary care hospital in rural central India six hours after full-term vaginal delivery, which was followed by pain in the lower abdomen. She had no history of cesarean section, laparoscopic procedures, or surgical termination of pregnancy, which would have predisposed her uterus to rupture. She was severely pale on arrival, and a contrast-enhanced computerized tomography scan revealed rupture of the left side of the uterus with hemoperitoneum and a large pelvic hematoma. Because the patient was in hemorrhagic shock, she was immediately taken for laparotomy with simultaneous resuscitative measures and blood transfusion on flow. Extensive uterine rupture, extending through the cervix to the round ligament of the left side involving the left lateral uterine wall, with active bleeding from the site of the defect was confirmed. The hematoma was 10 × 10 cm in size and was evacuated, following which peripartum hysterectomy was done. The left ureter was traced and safeguarded while applying the clamp on Mackenrodt’s ligament. The patient recovered completely following the procedure. She was discharged on day 13 in stable condition. She is currently doing well on follow-up and is a good example of a maternal near miss. In this report, we emphasize that, even in the absence of any obvious risk factor, uterine rupture can occur during labor, and monitoring the vitals of patients in the immediate postpartum period is essential to detect and promptly manage this serious condition for preventing maternal mortality.
format Online
Article
Text
id pubmed-8826621
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-88266212022-02-13 Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital Tayade, Surekha Chadha, Arzoo Khandelwal, Smriti Makhija, Nidhi Tilva, Hard Madaan, Sparsh Cureus Obstetrics/Gynecology Hemoperitoneum as a result of uterine rupture in a previously unscarred uterus is a rare entity to encounter and a potentially life-threatening condition. Ruptures can occur in a scarred uterus either spontaneously, due to operative manipulations, or with the use of uterotonic medications. In an unscarred uterus, spontaneous ruptures are known with high parity, use of oxytocin, and prolonged, neglected labor. Ruptures can be silent with no symptoms resulting in a delay in diagnosis and a near-miss situation. Here, we report the case of a 25-year-old young female who was referred to our tertiary care hospital in rural central India six hours after full-term vaginal delivery, which was followed by pain in the lower abdomen. She had no history of cesarean section, laparoscopic procedures, or surgical termination of pregnancy, which would have predisposed her uterus to rupture. She was severely pale on arrival, and a contrast-enhanced computerized tomography scan revealed rupture of the left side of the uterus with hemoperitoneum and a large pelvic hematoma. Because the patient was in hemorrhagic shock, she was immediately taken for laparotomy with simultaneous resuscitative measures and blood transfusion on flow. Extensive uterine rupture, extending through the cervix to the round ligament of the left side involving the left lateral uterine wall, with active bleeding from the site of the defect was confirmed. The hematoma was 10 × 10 cm in size and was evacuated, following which peripartum hysterectomy was done. The left ureter was traced and safeguarded while applying the clamp on Mackenrodt’s ligament. The patient recovered completely following the procedure. She was discharged on day 13 in stable condition. She is currently doing well on follow-up and is a good example of a maternal near miss. In this report, we emphasize that, even in the absence of any obvious risk factor, uterine rupture can occur during labor, and monitoring the vitals of patients in the immediate postpartum period is essential to detect and promptly manage this serious condition for preventing maternal mortality. Cureus 2022-01-10 /pmc/articles/PMC8826621/ /pubmed/35165541 http://dx.doi.org/10.7759/cureus.21076 Text en Copyright © 2022, Tayade et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Obstetrics/Gynecology
Tayade, Surekha
Chadha, Arzoo
Khandelwal, Smriti
Makhija, Nidhi
Tilva, Hard
Madaan, Sparsh
Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital
title Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital
title_full Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital
title_fullStr Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital
title_full_unstemmed Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital
title_short Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital
title_sort uterine rupture following non-operative vaginal delivery: a close save of delayed presentation with hemoperitoneum to a rural tertiary care hospital
topic Obstetrics/Gynecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826621/
https://www.ncbi.nlm.nih.gov/pubmed/35165541
http://dx.doi.org/10.7759/cureus.21076
work_keys_str_mv AT tayadesurekha uterinerupturefollowingnonoperativevaginaldeliveryaclosesaveofdelayedpresentationwithhemoperitoneumtoaruraltertiarycarehospital
AT chadhaarzoo uterinerupturefollowingnonoperativevaginaldeliveryaclosesaveofdelayedpresentationwithhemoperitoneumtoaruraltertiarycarehospital
AT khandelwalsmriti uterinerupturefollowingnonoperativevaginaldeliveryaclosesaveofdelayedpresentationwithhemoperitoneumtoaruraltertiarycarehospital
AT makhijanidhi uterinerupturefollowingnonoperativevaginaldeliveryaclosesaveofdelayedpresentationwithhemoperitoneumtoaruraltertiarycarehospital
AT tilvahard uterinerupturefollowingnonoperativevaginaldeliveryaclosesaveofdelayedpresentationwithhemoperitoneumtoaruraltertiarycarehospital
AT madaansparsh uterinerupturefollowingnonoperativevaginaldeliveryaclosesaveofdelayedpresentationwithhemoperitoneumtoaruraltertiarycarehospital