OBSTETRIC UTERINE RUPTURE OF THE UNSCARRED UTERUS: A CASE SERIES OF SIX

Abstract

Objectives: Uterine rupture in an unscarred uterus is a reality. It is a rare obstetrical complication that requires prompt diagnosis and immediate management. The aim of our study is to describe and analyze the epidemiological characteristics, maternal and fetal prognostic elements, and different therapeutic modalities of uterine rupture in an unscarred uterus.

Methods: This is a descriptive retrospective study spanning a 6-year period from 2017 to 2022.

Results: The incidence was 1.7/10,000 deliveries, with a mean maternal age of 31.3 years. All patients were multiparous, and rupture occurred during labor in all cases. The main clinical presentation was a non-reassuring fetal heart rate tracing. Surgical treatment was conservative in 4 out of 6 cases. There were no maternal deaths, but the fetal prognosis was severe, with two fetal deaths.

Conclusion: Unscarred uterine rupture is a rare but serious obstetric complication. In this series, maternal-fetal morbidity and mortality were high, consistent with the literature.

Keywords:

Uterine rupture , Unscarred uterus, Prognosis

References

Gibbins KJ, Weber T, Holmgren CM, Porter TF, Varner MW, Manuck TA. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol 2015;213(3). 382.e1-382.e6.

Catanzarite V, Maida C, Thomas W, Mendoza A, Stanco L, Piacquadio KM. Prenatal sonographic diagnosis of vasa previa: ultrasound findings and ob-stetric outcome in ten cases. Ultrasound Obstet Gynecol 2001;18(2):109-15.

Abiodun P. A, Ijaiya MDA, Yahaya UR. Ruptured Uterus: A Study of 100 Consecutive Cases in Ilorin, Nigeria. J Obstet Gynaecol Res. Dec 2001;27(6):3418-.

Elkady AA. Elkady AA, Bayomy HM, Bekhiet MT, Nagib HS, Wahba AK. A review of 126 cases of ruptured gravid uterus. Int Surg 1993;78(3):231-5.

Hofmeyr GJ, Say L, Gülmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG Int J Obstet Gynaecol. Sept 2005; 112(9) :12218-.

Al-Zirqi I, Daltveit AK, Vangen S. Infant outcome after complete uterine rupture. Am J Obstet Gynecol. Jul 2018;219(1):109.e1-109.e8.

Mulot S, Thibon P, Rikelman S, Andre M, Dreyfus M, Benoist G. Uterine rupture of the unscarred uterus: A report of 10 cases. Gynecol Obstet Fertil Senol. 2018 Nov;46(10-11):692695.

French. doi:10.1016/j.gofs.2018.09.007.Epub2018 Oct4. PMID:30293949.

Phuapradit W, Herabutya Y, Saropala N. Uterine rupture and labor induction with prostaglandins. J Med Assoc Thai 1993 May;76(5): 292-5.

Sweeten KM. Sweeten KM, Graves WK, Athanassiou A. Spontaneous rupture of the unscarred uterus. Am J Obstet Gynecol 1995;172(6):1851-5.

Sho EP, Wells M, Baxter T, Lane G. Recurrent spontaneous uterine rupture in a nulliparous young woman. Br J Obstet Gynaecol 1995;102(5):420-1.

D Toumi, M amina, R Issa ,A Grassi, I Miladi, E Guerbej et al. Severe anaemia revealing uterine rupture late in postpartum : case report.Jaccr Africa 2023 ;7(4) :47-52

Ahmadi S, Nouira M, Bibi M, Bouguizane S, Saidi H, Chaib A, et al. Uterine rupture in healthy pregnant uterus. About 28 cases. Gynécologie Obstétrique Fertil. Sept 2003;31(9):7137-.

Amate P, Aflak N, Luton D. Uterine rupture in pregnancy. EMC Obstet 2014;10 [5-080-A10].

Wang YL, Su TH. Obstetric uterine rupture of the unscarred uterus: a twenty-year clinical analysis. Gynecol Obstet Invest. 2006 ;62(3):1315-.

Gautier C, VanBelle Y, VanBogaert LJ, DeMuylder E. Uterine rupture: reflections on a spontaneous case in mid-pregnancy. J Gycol Obstet Biol Reprod 1985;4:201-9.

Fatfouta I, Villeroy de Galhau S, Dietsch J, Eicher E, Perrin D. Spontaneous uterine rupture in a healthy uterus during labour: case report and review of the literature. J Gynécologie Obstétrique Biol Reprod. Apr 2008;37(2):-2003.

Zwart JJ, Richters JM, Ory F, de Vries JIP, Bloemenkamp KWM, van Roosmalen J. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG Int J Obstet Gynaecol. July 2009;116(8):106978-; discussion 1078-1080.

Plauche WC, Von Almen W, Muller R. Catastrophic uterine rupture. Obstet Gynecol 1984;64:792-6.

Schrinsky DC, Benson RC. Rupture of the pregnant uterus: a review. Obstet Gynecol Surv 1978;33:217-32.