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Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 12

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Ginecol Obstet Mex 2020; 88 (12)

Vesicouterine rupture after vaginal delivery without previous uterine surgery. Case report and literature review

Díaz-Rabasa B, Espiau-Romera A, Laguna-Olmos M, Fernández-García C, Ruiz-Peña AC, Cebolla-Gil P

Language: Spanish
References: 17
Page: 905-911
PDF size: 306.77 Kb.


ABSTRACT

Background: Uterine rupture is an unpredictable and infrequent obstetric emergency which is associated to a high maternal and perinatal morbi-mortality. The most important risk factor is prior uterine surgery.
Objective: To report a complete vesicouterine rupture case occurred after a vaginal delivery without prior uterine surgery. It is intended to review the risk factors, the suspicious signs and symptoms, as well as the optimal management and maternal and perinatal prognosis of uterine rupture in unscarred uterus.
Clinic case: A 35-year-old woman, para 2 with neither uterine surgical procedures nor other medical records, had a normoevolutive pregnancy and required induction of labour with a dinoprostone vaginal slow-release system (10 mg) due to late-term pregnancy at 41+5 weeks. The labor progressed normally, ending in a vaginal delivery. After 1h postpartum, the patient started with a progressive abdominal pain and haematuria. The computerized tomography scan showed a severe hemoperitoneum and suggested the presence of a vesical continuity solution with disfiguration of the anterior and both lateral sides of the cervix, findings that were confirmed intraoperatively. Because of the severity of damages, a subtotal hysterectomy and a vesical reparation was performed.
Conclusions: Uterine rupture without prior uterine surgery seems to associate a higher maternal and perinatal morbi-mortality regarding cases occurred in scarred uterus. Diagnostic suspicion, even in the absence of risk factors, and early diagnosis and management are crucial to decrease it.


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