Silent rupture of unscarred uterus: an unusual presentation at second trimester abortion

Rupture of unscarred uterus during the second trimester is rare. A case of ruptured uterus in a multiparous woman is presented. To our knowledge, this might be the first reported case in the English literature of uterine rupture during second trimester termination of pregnancy using ethacridine lactate. This case is also rare as uterine rupture is presented with an insidious course rather than acute, thus delaying the diagnosis.     

Hypertonic saline as an abortifacient in a select group of patients

The clinical course of 40 patients with a uterine scar who were undergoing second-trimester abortion induced with either hypertonic saline or prostaglandin F2 alpha, was reviewed. In the 38 patients with a previous cesarean scar, and in the 2 patients with a hysterotomy scar, the uterine contents were evacuated with no evidence of uterine rupture. A review of the literature dealing with uterine rupture subsequent to induced midtrimester abortion revealed that the typical multiparous uterus was more prone to rupture if oxytocin was used in conjunction with or a few hours after instillation of the abortifacient, or if oxytocin was used continuously for more than 12 hours. Although rupture after use of prostaglandin in a previously scarred uterus has been reported, there is no case reported of rupture after use of hypertonic saline. This review and the authors' experience lead them to conclude that hypertonic saline is a safe abortifacient during the second trimester, especially between 18 and 22 weeks' gestation, in a previously scarred uterus when careful monitoring is employed and oxytocic agents are used judiciously.     

Oxytocin Induced Second Trimester Uterine Rupture

A case of oxytocin induced rupture of an unscarred uterus during the second trimester is presented. While rupture of the uterus by oxytocic agents in the second trimester has previously been documented, this case is unusual in that fetal parts were palpable through the cervical os, delaying diagnosis and definitive management. Digital palpation of fetal parts through the cervix does not preclude the diagnosis of fetal extrusion secondary to uterine rupture.     

Spontaneous asymptomatic uterine scar dehiscence at 20?weeks of gestation as a result of endomyometritis

Spontaneous uterine rupture during second trimester is a rarity in obstetrics. Rupture of the pregnant uterus is considered spontaneous if the rupture occurs without contractile activity of the myometrium. An unusual case of asymptomatic spontaneous uterine scar dehiscence in second trimester with previous three lower uterine segment caesarean sections following endomyometritis is presented here.     

Uterine rupture during second trimester abortion with misoprostol

BACKGROUND: Data are limited regarding the use of misoprostol in the midtrimester, therefore few cases with uterine rupture during the second trimester with a previous uterine scar have been reported in the literature. CASE REPORT: A 23-year-old woman with a prior low transverse cesarean section presented at 26 weeks' gestation for pregnancy termination for a fetal abnormality. She was given 200 microg misoprostol intravaginally every 3 h until regular contractions began. After the fourth dose, she had vaginal bleeding and severe contractions. She aborted completely 2 h later after the last dose. Uterine rupture was diagnosed at the previous cesarean section scar by manual vaginal examination. She underwent emergency laparotomy and the uterus was repaired. CONCLUSION: Misoprostol use in the second trimester in a woman with a uterine scar can trigger severe contractions that can lead to uterine rupture.     

Hysteroscopic Metroplasty

EDITORIAL COMMENT: Septate uterus is a common obstetric problem often first diagnosed during pregnancy when oblique fetal lie with breech presentation is noted in an asymmetrical heart-shaped uterus in the early third trimester. The diagnosis may also be made by hysterosalpingography in patients with habitual abortion, by early second trimester ultrasonography (although sometimes the ultrasonographer cannot identify the septum), or at the time of manual removal of a retained placenta. Most obstetricians have treated many patients with a septate uterus conservatively since the majority reproduce successfully. The question of metroplasty only arises when habitual abortion occurs. The remarkably few published series of metroplasties performed abdominally indicate that the operation is seldom performed. Hysteroscopic metroplasty seems so simple and effective that it appears reasonable to recommend it in any patient who has had 2 or more spontaneous miscarriages, especially if these occurred in the second trimester and resulted in the loss of a normally formed fetus. It is unlikely that a controlled trial on patients with a uterine septum and a history of spontaneous abortion will be performed to determine the extent to which metroplasty improves reproductive performance. In the case reported here readers may question whether the blighted ovum at 9 weeks' gestation, and spontaneous abortion at 9 weeks, were related to the uterine septum. The need for laparoscopy at the time of hysteroscopic metroplasty merits emphasis.     

Seventeen week pregnancy in a rudimentary uterine horn revealed at routine ultrasonography

Pregnancy in a rudimentary horn of a bicornuate uterus is a rare and often fatal event. A case is presented of such a pregnancy detected in the second trimester routine ultrasonographic examination.     

Term delivery after repair of a uterine rupture during the second trimester in a previously unscarred uterus: a case report

BACKGROUND: Rupture of the unscarred gravid uterus is very rare. The event occurs mostly during the intrapartum period and is potentially catastrophic for both mother and fetus. The management in general is prompt termination of pregnancy and hysterectomy. CASE: A successful term delivery followed spontaneous rupture of the uterus during the second trimester and surgical repair. The uterus ruptured with no apparent risk factors at 26 weeks of gestation. The rent, at the right side of the fundus, was repaired without damaging the amniotic membrane. After the operation, the patient received tocolysis for irregular uterine contractions until 37 weeks' gestation and delivered a healthy, male infant by cesarean section. CONCLUSION: Spontaneous rupture of a nonlaboring, unscarred uterus, especially in the second trimester, is extremely rare. This report suggests that conservative treatment for spontaneous rupture of the uterus before fetal maturity may be considered as an alternative to hysterectomy.     

Uterine rupture following conservative surgery for interstitial pregnancy.

A case of uterine rupture following conservative surgery for interstitial pregnancy is presented. Even though the uterine cavity was not opened during removal of the ectopic pregnancy, attenuation of the muscle lead to subsequent rupture of the uterus in the second trimester. The option for medical termination of ectopic pregnancies located in the cornual portion of tubes is discussed.     

A twin pregnancy in a bicornuate uterus]

A case of twin pregnancy in bicornuate uterus with a fetus in each horn is presented. During the second trimester, the rudimentary horn ruptured. This horn was extirpated and two non viable fetus were delivered by cesarean section. Later on, the patient had another pregnancy in the unicornuate uterus. She was delivered at 36th week of pregnancy by cesarean section. The baby was in good condition.     

Recurrent incarceration and/or sacculation of the gravid uterus: A review

Retroverted uterine incarceration with sacculation of the anterior wall is reported to occur approximately in 1/3000 pregnancies. A literature search identified only one case report of incarceration of an anteflexed gravid uterus and six reported cases of recurrent incarceration and/or sacculation. We present a case of an incarceration of an anteflexed uterus in the first pregnancy, followed by a retroflexed incarceration in the second pregnancy. From this, a review is presented on recurrent uterine incarceration and/or sacculation.     

Uterine torsion in twin pregnancy

A case of uterine torsion in a 37-years-old woman during twin pregnancy is described. Diagnosis was made during caesarean section and the torsion successfully reduced through a standing laparotomy. Detorsion was accomplished by rotating the uterus to the left. A severe post-partum haemorrhage occurred and hysterectomy was required. The patient recovered and was discharged home with her baby. Uterine torsion at term is a rare obstetric event that occurs mainly in the third trimester with adverse maternal and neonatal consequences and raises several critical management considerations. We review possible diagnostic signs and management of this rare complication from literature.     

Bilateral dermoid cysts of the ovary in a pregnant woman: case report and review of the literature

Objective  Most nonphysiological ovarian masses discovered during pregnancy are benign dermoid cysts. The association of dermoid cysts with pregnancy has been increasingly reported since 1918. They usually present the dilemma of weighing the risks of surgery and anesthesia versus the risks of untreated adnexal mass. Method  We are reporting an illustrative case and presenting a review of the literature for recommendations regarding the management of such cases. Result  The bilateral dermoid cysts were surgically treated in the second trimester. Conclusion  Most references state that it is more feasible to treat bilateral dermoid cysts of the ovaries discovered during pregnancy if they grow beyond 6 cm in diameter. This is usually performed through laparotomy or very carefully through laparoscopy and should preferably be done in the second trimester.     

Placenta Praevia — A Review with Emphasis on the Role of Ultrasound

Considerable confusion exists in the literature as a result of the wide range of classification systems for placenta praevia (PP) and low-lying placenta. The discrepancy between frequency of low-lying placentas in the second trimester and PP at term reflects to a certain extent the lack of understanding of the anatomy and physiology of the pregnant uterus. It seems that 'placental conversion' is a real phenomenon and is probably due to the differential growth rates of the placenta and uterus. Maternal bladder overdistension and myometrial contractions account for only a small part of the discrepancy. Diagnostic ultrasound obviously has an important role in placental localization. The role of Magnetic Resonance Imaging remains to be determined. The management of patients with low-lying placenta diagnosed in the second trimester, and the frequency of repeat scans is determined largely by the management protocol of the attending obstetrician.     

Ultrasonographic diagnosis of Jarcho-Levin syndrome at 20 weeks' gestation in a fetus without previous family history

Jarcho-Levin syndrome (JLS; spondylothoracic dysplasia) is a congenital disease characterized by multiple vertebral and rib malformations, causing a short trunk dwarfism commonly leading to respiratory insufficiency and death during the first years of life. We describe a case diagnosed during the second trimester routine ultrasound scan for screening of fetal anomalies without a previous family history. The fetus had a severe disorganization of the spine and ribs, skeletal kyphosis, with several hemivertebrae and a small thorax. All of the findings at postmortem examination confirmed the ultrasound features and were consistent with the JLS. To the best of our knowledge there is only one case reported in the literature of a prenatal diagnosis of the syndrome in a family with low risk for the condition.     

A Case of Acute Appendicitis in Pregnancy

An unusual case of appendicitis in the second trimester of pregnancy is presented. The underlying pathology was shrouded by incomplete abortion. The patient's condition worsened after her uterus was evacuated and it was only at laparotomy that a ruptured appendix was discovered. The need for vigilance in suspecting appendicitis is heightened so as to reduce morbidity and mortality from appendicitis in pregnancy.     

Microphthalmos associated with Dartmouth combination chemotherapy in pregnancy: a case report

BACKGROUND: Use of Dartmouth combination chemotherapy in pregnancy is scarcely reported, with only 1 report of its use in the late second and third trimesters and no report of its use in the first trimester. CASE: This is the first reported case in which the Dartmouth combination chemotherapy regimen was inadvertently used in a pregnant woman during the first and second trimesters for treatment of metastatic melanoma. The infant was found to have isolated microphthalmos and severe hypermetropia at 1 year of age. CONCLUSION: Although a causal relationship cannot be established from a single case, this report does provide useful information to discourage the use of this chemotherapy regimen in the first trimester, which is the critical period for organogenesis.     

Rupture of a Dermoid Cyst during Pregnancy

Summary: A case of spontaneous rupture of an infected dermoid cyst during the third trimester of pregnancy is reported.
Removal of the cyst, which was adherent to the uterine fundus and sigmoid colon, was effected after the uterus had been emptied by Caesarean section. Transverse colostomy was necessary because of damage to the bowel at the time of operation. The post-operative course was complicated by subphrenic abscess.     

Incarceration of the retroverted gravid uterus: a report of four cases

Four cases of incarceration of the retroverted gravid uterus are described. Typical observations were: a rather low fundal height at vaginal examination, no detectable uterine cervix, and the fetal presenting part deeply impacted in the pelvic cavity. One spontaneous correction in the third trimester is described. In general a cesarean section under general anesthesia is indicated. Preoperative recognition of retroversion is important and may prevent intraoperative complications. Three cases showed micturition problems in the second trimester. All pregnant women with second trimester micturition problems should be examined for a possible retroverted uterus.