Unexpected Uterine Rupture: A Case Series and Review of Literature QR01-QR03
Dr. Sunita Dubey,
Assistant Professor, Department of Obstetrics and Gynaecology, Government Medical College and Hospital,
Sector 32, Chandigarh, India.
Unscarred uterine rupture is rare and disastrous for the mother and the fetus. It has been reported in each trimester of pregnancy and its presentation varies from silent uterine rupture to haemorrhagic shock. It may occur in prelabour stage, second stage or even in fourth stage of labour causing uncontrolled postpartum haemorrhage. Here, we report 4 cases of unscarred uterine rupture during labour. First case was of gravida 3, para 2 who came in shock following failed attempt of forceps application during second stage of labour. Laparotomy revealed uterine rupture with dead fetus. Second case was of gravida 2 para 1 who was referred in view of deep transverse arrest but she went into shock and uterine rupture was confirmed on laparotomy with delivery of an alive baby with poor APGAR score. Third case was of a primigravida who had cessation of uterine contraction after applying fundal pressure. Clinically, she was diagnosed with rupture uterus that was confirmed on laparotomy with delivery of still born baby. Fourth case was of a primigravida who was induced with misoprostol. She had fetal bradycardia followed by cessation of uterine contractions during second stage of labour. On laparotomy she had uterine rupture and a still born baby was delivered. All these cases were survived as a result of timely diagnosis and immediate laparotomy. All of them received multiple blood transfusions and discharged in satisfactory condition. High index of suspicion of an unscarred uterine rupture should be kept in mind irrespective of trimester or phase of labour. Immediate action must be taken to prevent major maternal and fetal morbidity.