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Uterine rupture following myomectomy in third trimester

Ivka Djaković orcid.org/0000-0003-2275-6389 ; Clinical Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Senka Sabolović Rudman ; Clinical Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Željko Djaković ; Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Center, Zagreb, Croatia
Vesna Košec ; Clinical Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia

Abstract

Rupture of gravid uterus is surgical emergency causing maternal and fetal morbidity and mortality. The risk of uterine rupture is associated with uterine scars caused by previous cesarean section, myomectomy, hysteroscopic procedures, and curettage. We report a case of a 40-year-old woman in 31st week of gestation with spontaneous uterine rupture. It was her third pregnancy. She had two healthy children from previous pregnancies. Her symptoms were abdominal pain, vomiting and pain in the right shoulder lasting for 12 hours prior to admission. Ultrasound examination at admission revealed a dead fetus in the abdomen and free fluid in the abdominal
cavity. She had previously undergone laparoscopic myomectomy. After myomectomy, she had one successful vaginal delivery. Every abdominal pain in pregnant woman with uterine scar should be carefully and promptly examined to exclude uterine rupture before further diagnostic procedures. This early time frame is essential for survival of the fetus and sometimes even of the mother. Uterine
rupture represents indication for immediate cesarean section and it should be performed within 25 minutes of the first signs of uterine rupture. As shown in the case presented, one successful vaginal
delivery after myomectomy is no guarantee for future pregnancies.

Keywords

Uterine rupture; Pregnancy; Uterine myomectomy; Laparoscopy – methods; Abdomen, acute; Case reports

Hrčak ID:

156229

URI

https://hrcak.srce.hr/156229

Publication date:

1.12.2015.

Article data in other languages: croatian

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