Abstract
Introduction
Posterior wall rupture of the uterus in presence of previous caesarean scar is an extremely rare and unpredictable event.
Case report
A 26-year old lady in her second pregnancy went into spontaneous labour at 41 weeks gestation. She had emergency caesarean section in her previous pregnancy. She made slow progress in labour to full dilatation without augmentation, but was noted to have fresh vaginal bleeding and breakthrough pain despite an epidural. Uterine scar rupture was suspected and an emergency lower segment caesarean section was carried out. Fresh intraperitoneal bleeding was noted but with an intact previous scar. The baby was delivered in good condition. A vertical posterior uterine wall rupture of the lower segment, 5 cm in length, was found to be bleeding profusely and was successfully repaired.
Discussion
Uterine rupture is a rare but serious complication. Usually the rupture occurs through the previous uterine scar. There are only four reported cases in the literature of posterior uterine rupture in labour through “healthy” uterine tissue in women with previous caesarean section. This is the first instance of fetal survival. The exact mechanism is unknown but likely to be a combination of factors including prostaglandin use, element of obstruction and strong inelastic scar.
Conclusion
Strict vigilance is required during labour in women with previous scar. Early recognition of imminent scar rupture should speed delivery and improve the outcome for mother and baby.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP (2001) Risk of uterine rupture during labor among women with a prior caesarean delivery. N Engl J Med 345(1):3–8
Hawe JA, Olah KS (1997) Posterior uterine rupture in a patient with a lower segment caesarean section scar complicating prostaglandin induction of labour. Br J Obstet Gynaecol 104(7):857–858
Wang PH, Yuan CC, Chao HT, Yang MJ, Ng HT (2000) Posterior uterine wall rupture during labour. Hum Reprod 15(5):1198–1199
Figueroa R, Garry D, Mackenzie AP. (2003) Posterior uterine rupture in a woman with a previous Caesarean delivery. J Matern Fetal Neonatal Med 14(2):130–131
Singhal SR, Agarwal U, Sangwan K, et al (2005) Intrapartum posterior uterine wall rupture in lower segment caesarean section scarred uterus. Acta Obstet Gynaecol Scand 84(2):196–197
Walsh CA, O’Sullivan RJ, Foley ME (2006) Unexplained prelabor uterine rupture in a term primigravida. Obstet Gynecol 108(3 Pt 2):725–727
Catalin S. Buhimschi, Irina A. Buhimschi, Shilpa Patel, Andrew M. Malinow, Carl P. Weiner (2005) Rupture of the uterine scar during term labour: contractility or biochemistry? BJOG 112(1):38–42
Beckley S, Gee H, Newton JR (1991) Scar rupture in labour after previous lower uterine segment caesarean section: The role of uterine activity measurement. BJOG 98:265–269
American College of obstetricians and gynecologists (1999) Vaginal birth after previous cesarean delivery. ACOG Pract Bull 5:558–565
Smith GCSS, Pell JP, Pasupathy D, Dobbie R (2004) Factors predisposing to perinatal death related to uterine rupture during attempted vaginal birth after caesarean section: Retrospective cohort study BMJ 329:375
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Majumdar, S., Warren, R. & Ifaturoti, O. Fetal survival following posterior uterine wall rupture during labour with intact previous caesarean section scar. Arch Gynecol Obstet 276, 537–540 (2007). https://doi.org/10.1007/s00404-007-0365-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-007-0365-x