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Affiliation(s)
- C Panayotidis
- Department of Obstetrics and Gynaecology, Torbay General Hospital NHS Trust, South Devon,
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Abstract
Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to determine any change in pattern of presentation, management and outcome of such patients. The birth register of 4,333 deliveries at the University of Nigeria Teaching Hospital Enugu from January 1997 and December 2000 were reviewed. Forty-one cases of ruptured uterus were identified and analysed. The incidence of uterine rupture was 1 in 106 deliveries with a mean maternal age of 31.2 years. The majority (75.6%) of the patients were multiparous and had some form of antenatal care (61%) with 19.5% of the total booked at the Teaching Hospital. Many (78.1%) of the patients were in labour for 24?hours or less and 22.0% had oxytocin to augment or induce labour. The majority (68.3%) had a previously scarred uterus and many (53.6%) had lower segment ruptures. At laparotomy 31.7% had repair alone, 29.2% had repair with tubal ligation, 22.0% subtotal hysterectomy and 17.1% total hysterectomy. Perinatal mortality was high (87.8%) and maternal mortality rate 48.8 per 1,000 deliveries. Labour in a previously scarred uterus was the most common aetiological factor followed by obstructed labour in a multiparous woman. The incidence of ruptured uterus is still rising at Enugu, Nigeria but maternal mortality, due to uterine rupture continues to fall. The most commonly performed surgery is repair with or without sterilisation rather than hysterectomy.
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Affiliation(s)
- H U Ezegwui
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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Hatremi R, Sameh A, Azza S, Najla M, Rym BH, Sami M, Faouzia Z, Radhi H. [Emergency embolization in gynaecological bleeding. Two case reports]. Tunis Med 2005; 83:492-4. [PMID: 16238279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Two patients with gynaecological hemorrhage underwent successfully trans-arterial embolization. The first womanhad an uncontrollable perineal hemorrhage following a delivery with forceps. Angiography showed extravasation of contrast from right and left vaginal artery. Hyperselective embolisation stopped the vaginal bleeding. The second woman had massive hemorrhage following radiotherapy for cervical cancer. Angiography demonstrated extravasation of contrast from both uterine arteries. The bleeding was controlled after hyperselective embolisation. Emergency arterial embolisation is a safe and effective means of control of irrepressible genital hemorrhage.
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Affiliation(s)
- Rajhi Hatremi
- Service d'Imagerie Médicale Hôpital Charles Nicolle, Tunis
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Abstract
OBJECTIVE The objective of our report is to present three cases of vesicouterine fistulas secondary to a cesarean delivery, a uterine rupture during labor, and radiation therapy. The delay between the onset of symptoms and the diagnosis varied between 3 and 7 years. Different techniques such as color Doppler sonography, excretory urography, cystography, CT, MRI, cystoscopy, vaginoscopy, and hysterography were performed with variable results, mostly negative and sometimes undefined. CONCLUSION The definitive diagnosis was made with contrast-enhanced helical CT after cystography in one case, unenhanced helical CT after hysterography in another case, and cystography in the third case. Vesicouterine fistula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and endoscopic tests. The diagnosis is made on imaging after opacification of the uterus or the bladder depending on the pressure gradient obtained and the location of the fistula in relation to the uterine isthmus.
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Affiliation(s)
- Tarek Smayra
- Department of Radiology, Hôtel-Dieu de France, Blvd. Alfred Naccache, Achrafieh, PO Box 16-6830, Beirut, Lebanon
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Rodero C, Royo S, Perez D, López F. Traumatic rupture of gravid uterus with fetus lying into abdominal cavity: is easy to diagnose? Eur J Obstet Gynecol Reprod Biol 2004; 117:252-3. [PMID: 15541869 DOI: 10.1016/j.ejogrb.2004.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2004] [Indexed: 11/26/2022]
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Kuczkowski KM. The parturient with a scarred uterus, uterine rupture and labor analgesia: facts and fiction. ACTA ACUST UNITED AC 2004; 23:839-40. [PMID: 15345260 DOI: 10.1016/j.annfar.2004.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Novi JM, Rose M, Shaunik A, Ramchandani P, Morgan MA. Conservative management of vesicouterine fistula after uterine rupture. Int Urogynecol J 2004; 15:434-5. [PMID: 15549264 DOI: 10.1007/s00192-004-1165-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Accepted: 03/15/2004] [Indexed: 11/28/2022]
Abstract
We report the closure of a vesicouterine fistula with conservative management utilizing an indwelling transurethral Foley catheter. Uterine rupture occurred during a trial of vaginal birth after cesarean section, necessitating an emergency cesarean section. Upon entry into the abdomen, the base of the bladder was noted to be involved in the uterine rupture. The bladder trigone and ureteral orifices appeared normal. A primary, two-layer bladder repair was performed. A cystogram on postoperative day 14 demonstrated a vesicouterine fistula. Conservative management involving bladder drainage for 21 days with a transurethral Foley catheter was successful in closure of the fistula. Vesicouterine fistula, a documented complication of uterine rupture due to attempted vaginal birth after previous cesarean section, can spontaneously resolve with conservative management alone.
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Affiliation(s)
- Joseph M Novi
- Department of Obstetrics and Gynecology, University of Pennsylvania, 5 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Sheiner E, Levy A, Ofir K, Hadar A, Shoham-Vardi I, Hallak M, Katz M, Mazor M. Changes in fetal heart rate and uterine patterns associated with uterine rupture. J Reprod Med 2004; 49:373-8. [PMID: 15214711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To determine changes in fetal heart rate (FHR) and uterine patterns preceding complete uterine rupture. STUDY DESIGN FHR and uterine patterns of 50 women with uterine rupture were compared with 601 tracings of controls without scarred uteri. Tracings were interpreted using the National Institute of Child Health and Human Development Research Planning Workshop guidelines. RESULTS Interobserver and intraobserver agreements of FHR and uterine tracings in the uterine rupture group were excellent (kappa of .96 for both variables). Comparing tracing patterns during the first stage, higher rates of severe fetal bradycardia (4.0% vs. 1.0%, P = .064), fetal tachycardia (8.0% vs. 2.3%, P = .042), reduced baseline variability (24.0% vs. 12.5%, P = .021), uterine tachysystole (10.0% vs. 0.8%, P < .001) and disappearance of contractions (6.0% vs. 0, P < .001) were noted among patients with uterine rupture as compared to the controls. During the second stage of labor, patients with uterine rupture had significantly higher rates of reduced baseline variability (47.8% vs. 7.7%, P < .001), severe variable decelerations (26.1% vs. 6.4%, P = .004), uterine tachysystole (22.0% vs. 0.5%, P < .001) and disappearance of contractions (13.0% vs. 0, P < .001). Using a backward, stepwise multiple logistic regression model, severe fetal bradycardia (OR = 8.2, 95% CI 2.2-31.0, P = .002) and uterine tachysystole (OR = should alert the 8.0, 95% CI 1.7-37.9, P = .008) were found to be independent patterns preceding uterine rupture during the first stage of labor. Likewise, during the second stage, reduced baseline variability (OR = 4.2, 95% CI 1.4-12.3, P = .009) and uterine tachysystole (OR = 42.3, 95% CI 10.6-168.3, P < .001) were independently associated with uterine rupture in another multivariable analysis. CONCLUSION Abnormal monitor patterns among women presenting with risk factors for uterine rupture, specifically uterine tachysystole, reduced baseline variability and severe bradycardia, should act as warning signs to the obstetrician.
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Affiliation(s)
- Eyal Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
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Kukla P, Borowicz J, Szczuka K, Malarczyk B, Janowski M, Plato A. [Massive pulmonary embolism during pregnancy treated with streptokinase and complicated by massive haemorrhage--a case report]. Kardiol Pol 2004; 60:505-9; discussion 509. [PMID: 15247967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
A case of a 27-year-old pregnant female (first trimester) is described. The patient was hospitalised due to pregnancy complications and immobilised for 3 weeks. At the end of this period patient's clinical condition rapidly deteriorated and she developed shock, followed by cardiac arrest. Echocardiography was consistent with acute pulmonary embolism and the patient received streptokinase. This treatment was complicated by a massive bleeding due to the rupture of the uterus. She underwent hysterectomy and recovered thereafter.
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Affiliation(s)
- Piotr Kukla
- Oddział Wewnetrzny Szpitala Specjalistycznego im. H. Klimontowicza, Gorlice, Poland
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Abstract
Twin-to-twin-transfusion syndrome (TTS) is a serious complication in about 15% of monochorionic twin pregnancies. In severe TTS, the anemic pump twin (donor) develops anhydramnios and the hypervolemic recipient tense polyhydramnios, which often first calls attention to the condition. The most common problems of TTS are fetal complications such as single or double intrauterine demise, spontaneous abortion, prematurity due to uterine distension leading to contractions, preterm rupture of membranes and ultimately neurological impairment. We report a pregnancy with TTS in which rapid development of polyhydramnios led to rupture of a scarred uterus at 19 weeks' gestation. To the best of our knowledge, this is the first report of a potentially lethal maternal complication of TTS.
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Affiliation(s)
- Boris Tutschek
- Department of Gynecology and Obstetrics, University Hospital, Düsseldorf, Germany.
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Affiliation(s)
- G Hayes
- RSPCA Greater Manchester Animal Hospital, 411 Eccles New Road, Salford M5 2NN
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Ezechi OC, Mabayoje P, Obiesie LO. Ruptured uterus in South Western Nigeria: a reappraisal. Singapore Med J 2004; 45:113-6. [PMID: 15029412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Rupture of the gravid uterus is a grave obstetric complication that is associated with high maternal and perinatal mortality rates. In Nigeria, the incidence remains high and continue to increase because of poverty, illiteracy, unavailability of manpower, poor supply of medical equipment and consumables, and dwindling health care funding. METHODS A 10-year retrospective review of all cases of ruptured uterus seen at the Obafemi Awolowo University teaching hospital complex in Ile Ife, Nigeria was conducted. RESULTS A total of 61 cases of ruptured uterus from 16,683 deliveries were recorded, giving a ratio of 1 in 273. Predisposing or aetiological factors for rupture were: prolonged labour (91.8 percent), grand multiparity (50.8 percent), injudicious use of oxytocin (41.0 percent), uterine scar (26.2 percent), obstetric manipulation (4.9 percent) and abnormal lie (14.8 percent). Fifty-six patients had surgery, of which 14 (25.0 percent) had total abdominal hysterectomy, 16 (28.6 percent) had subtotal hysterectomy, 15 (26.8 percent) had repair of the rupture and bilateral tubal ligation, and 13 (19.6 percent) had repair only. Thirteen maternal deaths occurred with a case fatality rate of 21.3 percent. CONCLUSION Ruptured uterus remains a problem in Nigeria, with primary health centres and mission houses being identified as major contributors to this condition. They primarily failed in the recognition of abnormalities in the antepartum and/or intrapartum periods, with delays in referral and the injudicious use of oxytocin.
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Affiliation(s)
- O C Ezechi
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.
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Gherman RB, Lockrow EG, Flemming DJ, Satin AJ. Conservative management of spontaneous uterine perforation associated with placenta accreta: a case report. J Reprod Med 2004; 49:210-3. [PMID: 15098892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Placenta accreta occurring in an unscarred uterus is exceedingly rare. Previous cases of spontaneous uterine perforation associated with placenta accreta were treated with hysterectomy. CASE A nulliparous woman was clinically diagnosed with placenta accreta when spontaneous vaginal delivery was complicated by postpartum hemorrhage and a retained placenta. Magnetic resonance imaging subsequently revealed focal areas of placenta accreta. Acute-onset abdominal pain and cul-de-sac fluid prompted diagnostic laparoscopy, which revealed a spontaneous uterine perforation in the right posterior-lateral aspect of the uterus. This area was oversewn, and the patient received 2 weeks of postoperative antibiotics because of Enterococcus faecalis bacteremia. CONCLUSION Spontaneous uterine perforation associated with placenta accreta can be managed conservatively.
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Affiliation(s)
- Robert B Gherman
- Division of Maternal/Fetal Medicine, Department of Obstetrics and Gynecology, National Naval Medical Center, Bethesda, Maryland 20889, USA
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Abstract
OBJECTIVES To determine the etiologic factors explaining the appearance of uterine rupture on unscarred gravid uterus and to value the maternal and foetal prognosis of this complication. PATIENTS AND METHODS The authors report a study of 28 cases of uterine rupture on unscarred gravid uterus, recorded between January 1989 and December 1997, at the department of obstetrics and gynecology, Farhat Hached University Hospital, Sousse, Tunisia. RESULTS Out of the 72283 deliveries during the study period, there were 28 ruptured uteri of unscarred uterus giving a hospital incidence of one in 2581 deliveries. Multiparity, neglected labour dystocia and obstetric procedure were the common etiologic factors accused in the occurring of this complication. To be added to these factors: the low socio-economic status of the patients and lack of antenatal care. The surgical management was conservative (repair) in 19 cases (67.9%); hysterectomy was indicated in nine cases (32.1%). Maternal and fetal morbidity and mortality were important: we deplore two maternal deaths (7.1%) and seven fetal deaths (24.1%). DISCUSSION AND CONCLUSION Uterine rupture on unscarred uterus is a relatively rare complication of the pregnancy. However, its incidence remains high in developing countries. Its occurrence is significantly associated with grandmultiparity, lack of antenatal care and low socio-economic status of the patients.
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Affiliation(s)
- S Ahmadi
- Service de gynécologie-obstétrique, CHU Farhat-Hached de Sousse, 4000 Sousse, Tunisie
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Abstract
OBJECTIVES This study aimed at determining risk factors and pregnancy outcome in women with uterine rupture. STUDY DESIGN We conducted a population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 1999. RESULTS Uterus rupture occurred in 0.035% (n=42) of all deliveries included in the study (n=117,685). Independent risk factors for uterine rupture in a multivariable analysis were as follows: previous cesarean section (odds ratio [OR]=6.0, 95% CI 3.2-11.4), malpresentation (OR=5.4, 95% CI 2.7-10.5), and dystocia during the second stage of labor (OR=13.7, 95% CI 6.4-29.3). Women with uterine rupture had more episodes of postpartum hemorrhage (50.0% vs 0.4%, P<.01), received more packed cell transfusions (54.8% vs 1.5%, P<.01), and required more hysterectomies (26.2% vs 0.04%, P<.01). Newborn infants delivered after uterine rupture were more frequently graded Apgar scores lower than 5 at 5 minutes and had higher rates of perinatal mortality when compared with those without rupture (10.3% vs 0.3%, P<.01; 19.0% vs 1.4%, P<.01, respectively). CONCLUSION Uterine rupture, associated with previous cesarean section, malpresentation, and second-stage dystocia, is a major risk factor for maternal morbidity and neonatal mortality. Thus, a repeated cesarean delivery should be considered among parturients with a previous uterine scar, whose labor failed to progress.
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Affiliation(s)
- Keren Ofir
- Department of Obstetrics and Gynecology, Faculty of Health Services, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Porcu G, Roger V, Sakr R, Carcopino X, Feugeas JL, Gamerre M. Normal pregnancy following first-trimester uterine rupture. Ultrasound Obstet Gynecol 2003; 22:550-551. [PMID: 14618673 DOI: 10.1002/uog.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Ohkuchi A, Onagawa T, Usui R, Koike T, Hiratsuka M, Izumi A, Ohkusa T, Matsubara S, Sato I, Suzuki M, Minakami H. Effect of maternal age on blood loss during parturition: a retrospective multivariate analysis of 10,053 cases. J Perinat Med 2003; 31:209-15. [PMID: 12825476 DOI: 10.1515/jpm.2003.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE An extensive study as to whether maternal age itself is a risk factor for blood loss during parturition. METHOD A total of 10,053 consecutive women who delivered a singleton infant were studied. The excess blood loss was defined separately for women with vaginal and cesarean deliveries as > or = 90th centile value for each delivery mode. The effects of 13 potential risk factors on blood loss were analyzed using multivariate analysis. RESULTS The 90th centile value of blood loss was 615 ml and 1,531 ml for women with vaginal and cesarean deliveries, respectively. A low lying placenta (odds ratio [OR], 4.4), previous cesarean (3.1), operative delivery (2.6), leiomyoma (1.9), primiparity (1.6), and maternal age > or = 35 years (1.5) were significant independent risk factors for excess blood loss in women with vaginal delivery. Placenta previa (6.3), leiomyoma (3.6), low lying placenta (3.3), and maternal age > or = 35 years (1.8) were significant independent risk factors for excess blood loss in women with cesarean sections. CONCLUSION A maternal age of > or = 35 years was an independent risk factor for excess blood loss irrespective of the mode of delivery, even after adjusting for age-related complications such as leiomyoma, placenta previa, and low lying placenta.
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Affiliation(s)
- Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan.
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Chauhan SP, Martin JN, Henrichs CE, Morrison JC, Magann EF. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: A review of the literature. Am J Obstet Gynecol 2003; 189:408-17. [PMID: 14520209 DOI: 10.1067/s0002-9378(03)00675-6] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the rate of uterine rupture and its complications as the result of trial of labor after previous cesarean delivery. STUDY DESIGN PubMed was searched from 1989 to 2001, with the terms "VBAC, uterine rupture," "trial of labor, uterine rupture," "cesarean delivery, uterine rupture," and "scarred uterus, rupture." For inclusion, reports had to contain data from at least 100 patients with trials of labor that included a description of adverse outcomes. Duplicate reporting from a single institution was excluded. Odds ratios and 95% CIs were calculated. RESULTS Seventy-two of the 361 articles (20%) that were identified met the inclusion criteria. A 6.2 per 1000 trial of labor rate of uterine rupture (total=880 uterine ruptures in 142,075 trials of labor) was determined. For every 1000 trials of labor the uterine rupture-related complication rate was 1.8 for packed red blood cell transfusion, 1.5 for pathologic fetal acidosis (cord pH<7.00), 0.9 for hysterectomy, 0.8 for genitourinary injury, 0.4 for perinatal death, and 0.02 for maternal death. The perinatal mortality rate was significantly lower among studies from the United States versus other countries (0.3 vs 0.6; odds ratio, 0.50; 95% CI, 0.26-0.94) and in series that exceeded 1000 patients (0.2 vs 1.7; odds ratio, 7.34; 95% CI, 3.94-13.69). CONCLUSION Although relatively uncommon, uterine rupture is associated with several adverse outcomes, depending on the time of the publication and the site and size of the population that was studied.
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Affiliation(s)
- Suneet P Chauhan
- Spartanburg Regional Medical Center, Spartanburg, SC 29303, USA.
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Abstract
A gravida 10 para 9, after one Cesarean section (CS) followed by four vaginal deliveries was admitted at term without uterine contractions complaining of abdominal pain. The type of uterine scar was unknown. Severe bradycardia was observed at admission and an emergency Cesarean section was performed. A complete uterine rupture was revealed, the fetus in intact membranes and placenta were found in the abdominal cavity.
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Affiliation(s)
- David Segal
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva 84101, Israel.
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Abstract
A reluctance to proceed with hysterectomy for obstetric hemorrhage may be a more likely cause of preventable death in obstetrics than a lack of surgical or medical skills. Every obstetric unit should have protocols available to deal with hemorrhage and, in addition, have specific guidelines for patients who object to blood transfusions for various reasons. Risk factors for hemorrhage should be identified antenatally, using all possible imaging modalities available, and utilizing multidisciplinary resources whenever possible. Novel strategies for prenatal diagnosis of abnormal placentation include advanced sonography and magnetic resonance imaging. Placement and utilization of arterial catheters for uterine artery embolization is becoming more widespread and new surgical technology such as the argon beam coagulator seems promising. When intra or postpartum hemorrhage is encountered, a familiar protocol for dealing with blood loss should be triggered. Timely hysterectomy should be performed for signs of refractory bleeding. Application of medical and surgical principles combined with recent technologic advances will help the obstetrician avoid disastrous outcomes for both mother and fetus.
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Affiliation(s)
- Tracy Shevell
- Division of Maternal-Fetal Medicine, Columbia Presbyterian Medical Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Affiliation(s)
- J D Seffah
- University of Ghana Medical School, Accra, Ghana.
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Abstract
PURPOSE OF REVIEW This brief review will focus exclusively on very recent developments and controversial aspects of vaginal birth after cesarean. Only papers published in 2001 or 2002 are included. RECENT FINDINGS Recent studies have addressed the intrapartum management of vaginal birth after cesarean patients and the safety of trial of labor compared with elective repeat cesarean. SUMMARY The recent trend has been towards a more cautious approach to vaginal birth after cesarean. Some are concerned that this trend may limit childbirth options for those women who wish to avoid repeat cesarean operations.
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Affiliation(s)
- Bruce L Flamm
- Kaiser Permanente Medical Center, Riverside, California 92505, USA.
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Segal S, Shemesh IY, Blumenthal R, Yoffe B, Laufer N, Ezra Y, Levy I, Mazor M, Martinowitz U. Treatment of obstetric hemorrhage with recombinant activated factor VII (rFVIIa). Arch Gynecol Obstet 2002; 268:266-7. [PMID: 14504866 DOI: 10.1007/s00404-002-0409-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2002] [Accepted: 01/26/2002] [Indexed: 11/25/2022]
Abstract
Recombinant activated factor VII (rFVIIa, NovoSeven) was used in three patients with massive obstetric hemorrhage due to placenta previa accreta, rupture of the uterus and pre-eclampsia with HELLP. Administration of the drug markedly decreased the bleeding and enabled control of the hemorrhage. rFVIIa seems to be an adjunctive hemostatic measure for the treatment of severe obstetric hemorrhage.
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Affiliation(s)
- S Segal
- Department of Obstetrics and Gynecology, Ben-Gurion University of The Negev, Barzilai Medical Center, Ashkelon, Israel 78306.
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Affiliation(s)
- Kiran Popli
- Department of Obstetrics and Gynaecology, Sunderlal Jain Hospital, Delhi, India
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Abstract
OBJECTIVES The aim of the study was to determine the etiologic and epidemiological aspects of the obstetrical uro-genital fistulas in Congo in order to propose a strategy of prevention. PATIENTS AND METHODS It is a retrospective study concerning 34 files of obstetrical uro-genital fistulas selected within 7 years in the department of Urology of the University Hospital Center of Brazzaville. The etiopathogenic, anatomoclinical and therapeutic aspects have been analysed for each file. RESULTS The uro-genital fistula represents 23% of the female admissions in urology and 85% of them are related to obstetrical causes. Fifty-five percent of the patients were less than 30 years old, most of them being primiparas. Sixty-one percent of the patients came from rural areas. The prolonged time of the delivering labour and the foetal extraction manoeuvres were the main mechanisms causing the fistulas. With the surgical therapy, 77% of the abnormalities have been treated. CONCLUSION In spite of progress made in the realm of surgical techniques, the best treatment for uro-genital fistulas remains their prevention as targeted on the education for health and the management of pregnant women. Besides, the development of the infrastructure of health and roads, the training and reeducation of the health personnel contribute to improve this management.
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Affiliation(s)
- P A Bouya
- Service d'urologie andrologie, CHU de Brazzaville, 13, boulevard du Maréchal-Lyautey, BP 959, Brazzaville, Congo
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Toppenberg KS, Block WA. Uterine rupture: what family physicians need to know. Am Fam Physician 2002; 66:823-8. [PMID: 12322775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Vaginal birth after cesarean section is common in this country. Physicians providing obstetric care should be aware of the potential complications. Uterine rupture occurs in approximately one of every 67 to 500 women (with one prior low-transverse incision) undergoing a trial of labor for vaginal birth after cesarean section. Rupture poses serious risks to mother and infant. There are no reliable predictors or unequivocal clinical manifestations of rupture, so physicians must maintain a high index of suspicion for possible rupture, especially in the presence of fetal bradycardia or other evidence of fetal distress. Management is surgery for prompt delivery of the infant and control of maternal hemorrhage. Newborns often require admission to an intensive care nursery. Prevention of poor outcomes depends on thorough anticipation and preparation. The physicians and the delivery institution should be prepared to provide emergency surgical and neonatal care in the event of uterine rupture.
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Affiliation(s)
- Keith Stone
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida 32610-0294, USA.
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30
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Abstract
OBJECTIVE The purpose of this study was to evaluate factors associated with severe metabolic acidosis or death in a situation of uterine rupture. STUDY DESIGN A retrospective study was performed with review of charts and electronic monitoring strips. RESULTS Between November 1988 and November 2000, a total of 23 cases of complete uterine rupture were identified from among 2233 trials of labor after a previous low transverse cesarean delivery. Nine neonates (39.1%) had severe metabolic acidosis (pH < 7.0); among these, hypoxic-ischemic encephalopathy was diagnosed in 3 neonates and another neonate died. Placental or fetal extrusion or both were associated with severe metabolic acidosis (P <.001) but not with the other factors (birth weight, induction of labor, use of oxytocin, use of epidural, and cervix dilatation). Two newborns with severe acidosis had impaired motor development even with an intervention time less than 18 minutes from the onset of prolonged deceleration to delivery. CONCLUSION When uterine rupture occurs, placental or fetal extrusion was the most important factor associated with severe metabolic acidosis. Prompt intervention did not always prevent severe metabolic acidosis and neonatal morbidity.
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Affiliation(s)
- Emmanuel Bujold
- Department of Obstetrics and Gynecology, Hôpital Ste-Justine and Université de Montréal, Quebec, Canada
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31
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Ouédraogo C, Bouvier-Colle MH. [Maternal mortality in West Africa: risk, rates, and rationale]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:80-9. [PMID: 11976581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
New information has been collected about maternal mortality which is becoming better known in the West African countries. However, estimated rates for these countries still exhibit wide discrepancies related to the methods used. The purpose of the present work was to describe the principal methods which can be used to estimate rates and to present the results observed in the six countries of the MOMA survey. Obstetrical causes of maternal death and their substandard care, pointed out by the audit carried out during the survey, are presented and discussed.
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Affiliation(s)
- C Ouédraogo
- Centre Hospitalier National de Ouagadougou, Burkina Faso
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32
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Minkoff H, McCalla S. Uterine rupture among women with a prior cesarean delivery. N Engl J Med 2002; 346:134-7. [PMID: 11806380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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33
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Pomata M, Ledda S, Erdas E, Oskorouchi R, Zonza C, Pisano G. [The general surgeon facing acute abdomen caused of gynecologic cause: diagnostic and therapeutic considerations on 2 cases]. G Chir 2002; 23:39-42. [PMID: 12043469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The general surgeon has sometimes to face problems arising from an acute abdomen due to gynecologic causes. Such conditions are mainly found in women in reproductive age; the most frequent pathologies are due to complications of ovarian cysts, perlvic inflammatory disease and extrauterine pregnancy. Some short clinical commentaries are herein presented on two cases of gynecologic acute abdomen: the first case reported is related to an intraperitoneal rupture of a large uterine sarcoma and the second an ovarian neoplasm associated with a diffuse peritonitis from perforation of tubo-ovarian abscess.
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Affiliation(s)
- M Pomata
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari
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34
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Affiliation(s)
- J T Goh
- Gold Coast Hospital, Southport, Australia
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35
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Bais JM, van der Borden DM, Pel M, Bonsel GJ, Eskes M, van der Slikke HJ, Bleker OP. Vaginal birth after caesarean section in a population with a low overall caesarean section rate. Eur J Obstet Gynecol Reprod Biol 2001; 96:158-62. [PMID: 11384799 DOI: 10.1016/s0301-2115(00)00416-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the clinical outcome of vaginal birth after caesarean section (VBAC) in a Dutch population with a low overall caesarean section (CS) rate of 6.5%. STUDY DESIGN Prospective population based cohort study of 252 patients with a previous caesarean section (CS). Outcome parameters were trial of labour (TOL), success rate and VBAC rate. RESULTS The TOL rate in the study cohort was 73%, success rate 77%, VBAC rate 56%. The reason for the previous CS influenced success rate. Complications, morbidity and mortality were not different between elective, emergency CS and TOL group, except for a higher incidence of haemorrhage more than 500 ml in the elective CS compared to the TOL group (29% versus 17%, relative risk (RR) 1.74 (1.15--2.34)). CONCLUSIONS In this Dutch study the success rate is comparable to rate in US study reports. Increase of the VBAC rate can mainly be achieved by increasing the number of women attempting TOL.
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Affiliation(s)
- J M Bais
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
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36
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Oral B, Güney M, Ozsoy M, Sönal S. Placenta accreta associated with a ruptured pregnant rudimentary uterine horn. Case report and review of the literature. Arch Gynecol Obstet 2001; 265:100-2. [PMID: 11409470 DOI: 10.1007/s004040000140] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity and mortality. A case of pregnancy in a rudimentary uterine horn with rupture 14 weeks after last menstrual period and is complicated with placenta accreta is presented. The patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn of a bicornuate uterus. Histologic examination of the specimen showed that placenta was accreta. The relative literature is reviewed and the association of placenta accreta in such situations is pointed out.
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Affiliation(s)
- B Oral
- Beta Patoloji Laboratuari, Hastane Caddesi, Isparta, Turkey.
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37
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Abstract
OBJECTIVE The purpose of this study was to analyze cervical dilatation patterns among women with uterine rupture by means of a mathematic model and to use the results to determine optimal intervention criteria. STUDY DESIGN This was a case-control review that compared a case patient group of 19 women with uterine rupture during labor with control groups with either no previous cesarean deliveries, vaginal birth after cesarean delivery, or failure of attempted vaginal birth after cesarean delivery. The mathematic model quantified dilatation and adjusted for conditions specific to each patient. Case patients were compared with matched control subjects by means of paired t tests, analysis of variance, odds ratios, and conditional logistic regression. RESULTS Dystocia was present in 31.6% to 47.4% of patients with uterine rupture, versus 2.6% to 13.2% of the control group with no previous cesarean deliveries (P< or =.001). The incidence of an arrest disorder among patients with uterine rupture was similar to that seen in the control group with failure of attempted vaginal birth after cesarean delivery. However, the interval from diagnosis to rupture or cesarean delivery was 5.5 +/- 3.3 hours among case patients with uterine rupture and 1.5 +/- 1.3 hours in the control group with failure of attempted vaginal birth after cesarean delivery. CONCLUSION When cervical dilatation was lower than the 10th percentile and was arrested for > or =2 hours, cesarean delivery would have prevented 42.1% of the cases of uterine rupture and resulted in excess 2.6% and 7.9% cesarean delivery rates among women with no previous cesarean deliveries and women with vaginal birth after cesarean delivery, respectively.
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Affiliation(s)
- E F Hamilton
- Department of Obstetrics and Gynecology, Royal Victoria Hospital and McGill University, Canada
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38
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Rogoszewski M, Fuchs R, Bednarczyk K, Szmit C, Szuścik P. [Peritoneal hemorrhage after rupture of the uterine ligament latum venous plexus during the 26th week of pregnancy]. Ginekol Pol 2001; 72:160-2. [PMID: 11398585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
The article presents a case of spontaneous rupture of the uterine venous plexus on the right side ih a 32 year old multipara in 26th week of pregnancy. Attention is called to diagnostic difficulties of this complication and methods of controlling venous bleeding are discussed.
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Affiliation(s)
- M Rogoszewski
- Oddziału Ginekologiczno-Połozniczego Wojewódzkiego Szpitala Specjalistycznego nr 3 w Rybniku
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39
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Abstract
BACKGROUND Several cases of spontaneous second trimester uterine rupture have been reported, but none as early as 15 weeks' gestation after classical cesarean and with placenta percreta. CASE A 23-year-old woman, gravida 5, para 3, at 15 37 weeks' gestation with a history of classical cesarean incision presented to the emergency department with abdominal pain, hypotension, and tachycardia. Ultrasound showed a normal intrauterine pregnancy. She developed worsening pain, abdominal rebound, and abdominal distention. On exploratory laparotomy, a large uterine rupture was found and hysterectomy was done. CONCLUSION Spontaneous uterine rupture after classical cesarean can occur as early as 15 weeks' gestation. Uterine rupture must be considered in differential diagnoses of severe abdominal pain even in the early second trimester.
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Affiliation(s)
- L K Endres
- Center for Reproductive Medicine and Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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40
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Ramsey PS, Johnston BW, Welter VE, Ogburn PL. Artifactual fetal electrocardiographic detection using internal monitoring following intrapartum fetal demise during VBAC trial. J Matern Fetal Med 2000; 9:360-1. [PMID: 11243295 DOI: 10.1002/1520-6661(200011/12)9:6<360::aid-mfm1008>3.0.co;2-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Absent or erratic fetal electrocardiographic signal can result in artifactual electronic fetal heart rate recording. We report a case where detection of maternal heart rate through internal fetal scalp monitor may have masked intrauterine fetal demise secondary to acute uterine rupture during a VBAC trial.
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Affiliation(s)
- P S Ramsey
- Department of Obstetrics and Gynecology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
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41
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Hayashi M, Mori Y, Nogami K, Takagi Y, Yaoi M, Ohkura T. A hypothesis to explain the occurence of inner myometrial laceration causing massive postpartum hemorrhage. Acta Obstet Gynecol Scand 2000; 79:99-106. [PMID: 10696956 DOI: 10.1034/j.1600-0412.2000.079002099.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inner myometrial lacerations were found in three patients who developed uncontrollable postpartum massive bleeding despite the usual treatment for uterine atony. Because all the patients suffered from hemorrhage shock and their medical status deteriorated, their uteri were surgically removed to stop bleeding. After removal, one of them died. Postpartum hemorrhage was caused by inner myometrial laceration. We hypothesized a cause of inner myometrial laceration, using the three resected uteri, an assumed model of the uterine body, and 34 women. METHODS The subjects were 37 women, of whom three were patients with inner myometrial laceration, 23 were women without inner myometrial laceration who underwent cesarean section, and 11 were women in the first stage of labor. The three resected uteri were examined both macroscopically and microscopically. We measured the thickness of the wall of the uterine muscle at the widest point of the uterine corpus and the thickness of the myometrial wall at a transverse section of the uterine cervix, as well as the radius of the inner lumen at the widest point of the uterus in 23 women during cesarean section. We also measured the thickness of the myometrial wall at the widest point of the uterine corpus in 11 women at the end of the first stage of labor during ultrasonic examination. The data were then used to estimate the stress on the uterine muscle. RESULTS The stress on the uterine cervix was stronger than that on the uterine corpus during labor. When the stress on the uterine muscle is stronger than a specific value, inner myometrial lacerations develop on the right and/or left side of the uterine cervix. These lacerations may involve large vessels. CONCLUSIONS We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor.
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Affiliation(s)
- M Hayashi
- Department of Obstetrics and Gynecology, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya-shi, Saitama, Japan
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42
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Abstract
BACKGROUND Cesarean scar rupture of a gravid uterus in early gestation is rare. CASE A 38-year-old woman, gravida 4, para 2-0-1-1, presented at 13 weeks' gestation with cramping and spotting. She had a history of two cesareans. Ultrasound and magnetic resonance imaging indicated probable uterine dehiscence and a viable extrauterine pregnancy. After embolization of the uterine arteries with subsequent fetal death, the subject had a hysterectomy. Intraoperatively, she had complete rupture of the lower uterine segment, but the pregnancy was enclosed within scar tissue between the uterus and bladder. Placenta percreta was found by histologic examination. CONCLUSION Women with histories of cesareans might be at risk of early uterine rupture.
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Affiliation(s)
- S Marcus
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle 98195-6460, USA.
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43
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Caughey AB, Shipp TD, Repke JT, Zelop CM, Cohen A, Lieberman E. Rate of uterine rupture during a trial of labor in women with one or two prior cesarean deliveries. Am J Obstet Gynecol 1999; 181:872-6. [PMID: 10521745 DOI: 10.1016/s0002-9378(99)70317-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to determine whether there is a difference in the rate of symptomatic uterine rupture after a trial of labor in women who have had 1 versus 2 prior cesarean deliveries. STUDY DESIGN The medical records of all women with a history of either 1 or 2 prior cesarean deliveries who elected to undergo a trial of labor during a 12-year period (July 1984-June 1996) at the Brigham and Women's Hospital were reviewed. Rates of uterine rupture were compared for these 2 groups. Potential confounding variables were controlled by using logistic regression analyses. RESULTS Women with 1 prior cesarean delivery (n = 3757) had a rate of uterine rupture of 0.8%, whereas women with 2 prior cesarean deliveries (n = 134) had a rate of uterine rupture of 3.7% (P =.001). In a logistic regression analysis that was controlled for maternal age, use of epidural analgesia, oxytocin induction, oxytocin augmentation, the use of prostaglandin E(2) gel, birth weight, gestational age, type of prior hysterotomy, year of trial of labor, and prior vaginal delivery, the odds ratio for uterine rupture in those patients with 2 prior cesarean deliveries was 4.8 (95% confidence interval, 1.8-13. 2) CONCLUSIONS Women with a history of 2 prior cesarean deliveries have an almost 5-fold greater risk of uterine rupture than those with only 1 prior cesarean delivery.
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Affiliation(s)
- A B Caughey
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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44
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Abstract
The successful delivery in a 31 year old woman at 33 weeks gestation is reported, after repair to a cornual rupture which occurred at 21 weeks gestation. The patient exhibited acute abdominal pain and pending shock. Emergency laparotomy showed a cornual rupture and an intrauterine vital fetus having intact amnion membrane. On the patient's family's insistence, primary repair for a cornual rupture was performed and preservation of the fetus attempted. Postoperatively, tocolytic agent with ritodrine hydrochloride was administered and close follow-up of the patient was uneventful. The patient had a smooth obstetric course until 33 weeks gestation when premature rupture of the membranes occurred, soon followed by the onset of labour. She underwent an elective Caesarean section and delivered a normal male fetus weighing 2140 g with Apgar scores at 1, 5 and 10 min of 6, 8, and 9 respectively. Because of this successful outcome, we suggest that primary repair for such an unusual patient should be accepted.
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Affiliation(s)
- P H Wang
- Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei and National Yang-Ming University, 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
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45
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Rosser J. Ruptured uterus. Pract Midwife 1999; 2:38-9. [PMID: 10358661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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46
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ACOG educational bulletin. Postpartum hemorrhage. Number 243, January 1998 (replaces No. 143, July 1990). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1998; 61:79-86. [PMID: 9622181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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47
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 9-1998. Cardiovascular collapse after vaginal delivery in a patient with a history of cesarean section. N Engl J Med 1998; 338:821-6. [PMID: 9508626 DOI: 10.1056/NEJM199803193381208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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48
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Harrahill M. Maternal trauma care: a brief review. J Emerg Nurs 1997; 23:649-50. [PMID: 9460407 DOI: 10.1016/s0099-1767(97)90291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M Harrahill
- Oregon Health Sciences University, Portland, USA
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49
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Onuora VC, al Ariyan R, Koko AH, Abdelwahab AS, al Jawini N. Major injuries to the urinary tract in association with childbirth. East Afr Med J 1997; 74:523-6. [PMID: 9487420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This retrospective study was designed to determine the incidence of major injuries to the urinary tract that occur during parturition and to assess their management. Twenty one such injuries were managed at the maternity wing of the Riyadh Medical Complex in a four-year period. They occurred during a total delivery of 48,693. This gives an incidence of major urinary trauma of 43 per 100,000 births. There were 4,622 deliveries by caesarean section, giving a section rate of 9.5%. Of ten cases of severe bladder injuries, seven occurred in association with ruptured uteri, and three at repeat caesarean sections. One case of bladder rupture involved injury to the ureters, and another was associated with vaginal laceration and traumatic vesico-vaginal fistula. All bladder injuries were discovered either on the table or soon after delivery. Ten women sustained ureteric injuries. Five injuries occurred during caesarean section, three at caesarean hysterectomies, two were avulsed from a ruptured bladder and another was ligated during repair of a deep cervical laceration. Only one case of ureteric injury was made intra-operatively. The others (90%), were discovered in the early puerperium, ranging from five to twenty one days. There was one case of rupture of a diseased kidney during labour. She presented soon after delivery and had nephrectomy. Haemorrhage was profuse in many cases and warranted hysterectomy in six cases, internal iliac artery ligation in three cases, and both procedures in one case. Assessment of viability of tissues and integrity of the ureters was made difficult by bleeding. Successful bladder repair was achieved in nine out of ten women employing limited excision of tissues and liberal drainage. Exploration and repair of ureteric injuries was preceded by a period of percutaneous nephrostomy drainage. This approach was associated with good results.
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Affiliation(s)
- V C Onuora
- Department of Urology, Riyadh Medical Complex, Riyadh, Saudi Arabia
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50
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Gudgeon CW. Uterine rupture and scar dehiscence. Anaesth Intensive Care 1997; 25:434. [PMID: 9288397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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