DR FARAH WAQAR

SILENT UTERINE RUPTURE

36 year old femaleG3P2+0,1 alive issue and 1 FSBPrevious 2 LSCSLast delivery 1 year back.LMP:08/09/2011EDD:15/06/2012

uneventful

Antenatal course

Admitted through E/R on 27/01/2012 at 20weeks gestation at 0130 hours with history of fall on the floor followed by generalized body ache.

ON ADMISSION: On General physical examination: Bruises on the forehead, nose and lips

noticed. Rest of examination was unremarkable.

vitals: B.P:123/80mmHg Pulse:88 beats/minute Temperature:36.2 R/R: 22 breaths/minute Oxygen saturation : 99 %

ABDOMINAL EXAMINATION: soft, non-tender, uterine contour intact. FHM: 26 cms Multiple fetal parts palpable FHS:Twin 1=+….???souffle Twin 2=absent P/V bleeding - Nil

Primary consultant informed who advised U/S pelvis

Ultrasound done which revealed monochorionic,diamniotic twin intrauterine fetuses,corresponding to 23 weeks and 21 weeks.

Fetal cardiac activity and movements are absent in both twins.

Evidence of polyhydramnios noted.

A large area of blood collection measuring 8.8x7.8cms is noted near the internal os.

Primary consultant informed.Hysterotomy planned.

uterine rupture found in the middle of lower segment extending laterally on the left side below the bladder base, but not involving the bladder.

Both fetuses and placenta lying in the peritoneal cavity.

haemoperitoneum found.Uterine repair done in two layers.

OPERATIVE FINDINGS

EBL=1 LiterTubal ligation advised but husband refused

Uterine rupture during pregnancy is commonly due to disruption of a previous cesarean scar.

It usually occurs during the third trimester and is rare in the second trimester.

There are few case reports of uterine rupture in midtrimester abortion associated with the use of prostaglandins.

unavoidable because it was secondary to trauma.

Root cause