medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2023, Number 04

<< Back Next >>

Ginecol Obstet Mex 2023; 91 (04)

Uterine rupture associated with uterus didelphus and placenta accreta. A case report

Gil-Peralta D, Betanzos-Ramírez F, Mandujano-Álvarez GJ, Martínez-Hernández CM, Arias-Escayola KE

Language: Spanish
References: 15
Page: 280-285
PDF size: 450.49 Kb.


ABSTRACT

Background: Müllerian malformations are the consequence of an alteration in the formation of the Müllerian ducts during fetal development. The time at which the alteration occurs determines the type of malformation. The current classification is that of the American Society for Reproductive Medicine (ASMR), which is associated with multiple obstetric complications, among the most serious of which is uterine rupture.
Clinical case: A 23-year-old primigravid patient, 39.1 weeks pregnant, with no personal pathological history for the current condition, without prenatal control, with severe generalized abdominal pain and decreased fetal movements for 12 hours prior to her evaluation. On the patient admission to the hospital her fetus was found dead; hemoglobin 7.9 g/dL, blood pressure 96-53 mmHg, tachycardic, with clinical data of peritoneal irritation. At exploratory laparotomy the fetus was found dead, in abdominal cavity. Hemoperitoneum of 1300 mL, didelphic uterus, with uterine rupture towards the fundus. Data of placental accretism. Therefore, obstetric hysterectomy was performed, with bleeding of 2000 cc. Resuscitation and a 24-hour stay in the intensive care unit was necessary. The abdomino-pelvic CT scan showed no renal alterations, with an adherent tumor near the parietal peritoneum suggestive of ectopic kidney. The puerperium was uneventful, and she was discharged from the hospital.
Conclusion: In pregnancy, Müllerian malformations are a cause of serious obstetric complications, including uterine rupture. Timely diagnosis is decisive for the prevention of complications and prenatal management.


REFERENCES

  1. Theodoridis TD, Pappas PD, Grimbizis GF. Surgical managementof congenital uterine anomalies (including indicationsand surgical techniques). Best Pract Res Clin ObstetGynaecol 2019; 59: 66-76. http://dx.doi.org/10.1016/j.bpobgyn.2019.02.006

  2. Naeh A, Sigal E, Barda S, Hallak M, et al. La asociaciónentre las anomalías uterinas congénitas y los resultadosperinatales: ¿importa el tipo de defecto? J Matern FetalNeonatal Med 2021; 1-6. http://dx.doi.org/10.1080/14767058.2021.1949446

  3. Passos I de MPE, Britto RL. Diagnóstico y tratamientode las malformaciones müllerianas. Taiwan J Obstet Gynecol2020; 59 (2): 183-8. http://dx.doi.org/10.1016/j.tjog.2020.01.003

  4. Pfeifer SM, Attaran M, Goldstein J, Lindheim SR, et al. Clasificaciónde anomalías müllerianas ASRM 2021. FertilSteril 2021; 116 (5): 1238-52. http://dx.doi.org/10.1016/j.fertnstert.2021.09.025

  5. O’Flynn O’Brien KL, Bhatia V, Homafar M, Gong YY, et al. Theprevalence of Müllerian anomalies in women with a diagnosed renal anomaly. J Pediatr Adolesc Gynecol 2021; 34(2): 154-60. http://dx.doi.org/10.1016/j.jpag.2020.11.015

  6. Conde-Gutiérrez YS, Cruz-López N, Jiménez-Ibáñez LC.Útero didelfo como causa de ruptura uterina espontánea.Reporte de un caso. Gineco Obstet Méx 2020; 88 (6): 407-11. https://doi.org/10.24245/gom.v88i6.3705

  7. Carbonnel M, Pirtea P, de Ziegler D, Ayoubi JM. Uterinefactors in recurrent pregnancy losses. Fertil Steril 2021;115 (3): 538-45. http://dx.doi.org/10.1016/j.fertnstert.2020.12.003

  8. Velandia-Avendaño MC, Sepúlveda-Agudelo J. Revisión dela clasificación y diagnóstico de malformaciones müllerianas.Rev Médica UIS 2018; 31 (2): 57-63. http://dx.doi.org/10.18273/revmed.v31n2-2018007

  9. Vilanova-Blanes E, Oltra-Escoda MF, Rodríguez-Ingelmo JM.Rotura uterina por placenta percreta. Un caso clínico enútero bicorne unicollis. Prog Obstet Ginecol 2008; 51 (8):492-6. http://dx.doi.org/10.1016/s0304-5013(08)72320-3

  10. Jáuregui-Meléndrez RA. Estado actual de la clasificación,diagnóstico y tratamiento de las malformaciones müllerianas.Ginecol Obstet Mex 2013; 81: 34-46.

  11. Rodríguez-Garnica MD, Fernández-Muñoz L, Oñate-TejadaS, García-Pineda V, et al. Rotura de cuerno uterino rudimentarioen gestación de 22 semanas. A propósito de uncaso y revisión de la literatura. Prog Obstet Ginecol 2014;57 (5): 216-9. http://dx.doi.org/10.1016/j.pog.2013.11.008

  12. Jayaprakasan K, Ojha K. Diagnosis of congenital uterineabnormalities: Practical considerations. J Clin Med 2022;11 (5): 1251. http://dx.doi.org/10.3390/jcm11051251

  13. Dekalo A, Feldstein O, Tal D, Friedman M, et al. The associationof placental histopathological lesions and adverseobstetric outcomes in patients with Müllerian anomalies.Placenta 2022; 122: 23-8. http://dx.doi.org/10.1016/j.placenta.2022.03.123

  14. Cahen-Peretz A, Walfisch A, Friger M, Sheiner E. Maternalmüllerian anomalies and future health of the offspring.Eur J Obstet Gynecol Reprod Biol.2017; 212: 20-4. http://dx.doi.org/10.1016/j.ejogrb.2017.02.010

  15. Aguilar-Gallardo C, García-Herrero S, Vicente-Medrano J,Melo MAB. Pronóstico reproductivo de las malformacionesmüllerianas. Prog obstet ginecol. 2008; 51 (12): 72136.http://dx.doi.org/10.1016/s0304-5013(08)76314-3




2020     |     www.medigraphic.com