TRAUMATIC UTERINE RUPTURE SEALED BY A HEMATOMA: A RARE CASE OF MATERNAL AND NEONATAL SURVIVAL

Abstract

Background: Uterine rupture is a rare but severe obstetric complication associated with high maternal and neonatal mortality. It typically requires immediate intervention to prevent significant maternal and fetal morbidity. The condition is more common in women with previous cesarean sections but can also occur spontaneously or after trauma, as in the case described here. Early diagnosis and prompt surgical management are essential to minimize risks and ensure favorable outcomes.

Case Presentation: We report an unusual case of complete uterine rupture in a 38-year-old patient at 38 weeks of gestation. The rupture occurred several hours after a minor trauma. The patient presented to the emergency department with persistent pelvic pain and vaginal bleeding, symptoms that had initially been neglected. Clinical and fetal assessment revealed fetal heart decelerations, prompting an emergency cesarean section. During the surgery, a complete uterine rupture was discovered, sealed by a 300 cc hematoma. The newborn displayed mild respiratory distress but showed improvement post-delivery, while the mother’s recovery was also successful following uterine repair.

Conclusion: This case underscores the importance of clinical vigilance in monitoring pregnant patients, particularly those with a history of cesarean section. It highlights the potential for temporary stabilization of uterine rupture through hematoma formation, which can provide a critical window for timely intervention. The favorable outcomes in both the mother and infant demonstrate the importance of prompt management in obstetric emergencies.

Keywords:

Uterine rupture, Obstetric complication, Cesarean section, Maternal outcomes, Neonatal outcomes

References

Turner MJ. Uterine rupture. Best Pract Res Clin Obstet Gynaecol. 2002 Feb;16(1):69-79. doi: 10.1053/beog.2001.0256. PMID: 11866498.

Donati S, Fano V, Maraschini A. Uterine rupture: Results from a prospective population-based study in Italy. Eur J Obstet Gynecol Reprod Biol. Sept 2021;264: 70 5. PubMed| Google Scholar

Guèye SMK, Moreau JC, Moreira P, Faye EO, Cissé CT, De Bernis L, et al. Rupture utérine au Sénégal. J Gynecol Obstet Biol Reprod 2001; 30:700-5.

Farhat IB, Zoukar O, Medemagh M, et al. Etude rétrospective sur 60 cas de rupture utérine du centre de maternité de Monastir, Tunisie [Retrospective study of 60 cases of uterine rupture at the Maternity Center of Monastir, Tunisia]. Pan Afr Med J. 2024; 47:83. Published 2024 Feb 26. doi:10.11604/pamj.2024.47.83.42188

Guise JM, Eden K, Emeis C, et al. Vaginal birth after cesarean: new insights. Evid Rep Technol Assess (Full Rep). 2010;(191):1-397.

Azouz I, Souissi B, Ayadi M, Hakim H, Gassara H, Talbi S, Mahfoudh KB. Traumatic uterine rupture: A rare complication of vehicle accidents. Radiol Case Rep. 2024 Feb 29;19(5):1994-1997. doi: 10.1016/j.radcr.2024.02.020. PMID: 38440740; PMCID: PMC10909957.

Vilchez G, Nazeer S, Kumar K, Warren M, Dai J, Sokol RJ. Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study. Arch Gynecol Obstet. nov 2017;296(5): 869 75. PubMed| Google Scholar

Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, Subtil D. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol. Août 2014;179: 130 4. PubMed| Google Scholar

Fatfouta I, Villeroy de Galhau S, Dietsch J, Eicher E, Perrin D. Rupture spontanée sur uterus sain pendant le travail: à propos d’un cas et revue de la literature. J Gynecol Obstet Biol Reprod 2008;37: 200-3.

Camara, D., Kone, J., Bocoum, A., Keita, M. A., Traoré, A., Kouma, A., Traore, S. O., Konare, M., & Traore, Y. (2020). Rupture Utérine de Diagnostic Tardif et Inopiné en Peropératoire après un Accouchement Dystocique par Voie Basse. HEALTH SCIENCES AND DISEASE, 21(3). https://doi.org/10.5281/hsd.v21i3.1884

Guyot A, Carbonnel M, Frey C, Pharisien I, Uzan M, Carbillon L. Rupture utérine: facteurs de risque, complications maternelles et fœtales. J Gynécologie Obstétrique Biol Reprod. mai 2010;39(3): 238 45. PubMed| Google Scholar.