Rupture of Uterus - Miracles Sometimes Happens

Abstract

Introduction. Uterine rupture is very rare, but serious complication of pregnancy. It could be fatal for both, mother and fetus. There are a few golden minutes to save fetus and dramatic fight for parturient life and further fertility. Case description. 49 years old parturient at 31 weeks of gestation after in vitro fertilization(IVF) procedure was admitted to the hospital due to mild pain and irregular uterus contractions. Her obstetric anamnesis was complicated: one miscarriage at 16 weeks of gestation after IVF procedure, Group B streptococcus colonization, cervical cerclage at 13th week of pregnancy was performed to prevent premature birth, laparoscopic removal of myoma 4 years ago. Patients vital signs were stable, cardiotocography was normal, just minimal vaginal bleeding about150ml of fresh blood was detected. Placental abruption was suspected. First urgency category Cesarean section was performed under general anesthesia. Two 16G intravenous lines were inserted and infusion with crystalloids was started. Blood products were ordered. After incision of abdominal wall the fetus and placenta were removed from peritoneal cavity together with two liters of blood. Apgar scores 1 and 5 minutes were 5 and 8 respectively. Uterine fundus rupture was detected. As uterine atony was resistant to conservative treatment, total hysterectomy was performed. Total blood loss was 2500 ml. Two units of red blood cells, 2 units of fresh frozen plasma and 6 units of cryoprecipitate were transfused. Summary. This case report presents a rare complication - rupture of uterus and demonstrates that despite of many risk factors it is hard to predict or prepare to such challenge and good results depend on fast reaction to changing circumstances. Conclusions. Multiple intrauterine manipulations increases the risk of fatal complications during pregnancy. Event a few milliliters of fresh blood can be a sign of dramatic situation and requires immediate decisions.