Spontaneous rupture of uterine vessels during pregnancy, about three cases

Spontaneous rupture of uterine vessels during pregnancy is an exceptional event which remains little known by the gynecologists. Being given its important morbi-mortality, we wanted to make a reminder of this pathology through three cases arisen in the CHU of Grenoble. All patients experienced acute abdominal pain. In two cases out of three, birth followed vaginal delivery. No maternal death was deplored. Fetal prognosis remains poor, as one is dead among our three cases. Clinical signs are sensible but not specific. Early management requires efficient resuscitation then surgical haemostasis, and has to be teatched in order to improve its prognosis.     

Spontaneous hepatic rupture during an uncomplicated twin pregnancy

Liver subcapsular haematoma and its consequence, spontaneous hepatic rupture, are very rare complications of pregnancy. They are mainly associated with pre-eclampsia. The diagnosis is difficult and the maternal and fetal mortality rates are high. We report the case of a spontaneous hepatic rupture on a normal liver during an uncomplicated twin pregnancy with a favorable outcome for both the mother and the newborns.     

Spontaneous rupture of the uterine pedicle during pregnancy: Three case reports

We report a retrospective review of three cases presenting with spontaneous uterine artery rupture during pregnancy. Clinical presentations were intra-peritoneal haemorrhage for two of them and in utero fetal death for the last one. Fetal outcome was poor in all three cases. Uterine vessels spontaneous rupture during pregnancy is an exceptional event. Considering our experience and the literature review, we propose a guideline for vascular rupture during pregnancy.     

Case series of uterine rupture and subsequent pregnancy outcome

OBJECTIVE: TO review the incidence of ruptured uterus at Women's Hospital, Hamad Medical Corporation (HMC), highlight the management approach of suture repair in relation to maintaining the patient's future fertility, and study subsequent pregnancy outcome and the risk of recurrent uterine rupture. METHODS: Case notes were reviewed for every patient with a ruptured uterus at the Women's Hospital in Doha for a period of 15 years, from 1 January 1983 to 31 December 1997. RESULTS: There were 17 cases of ruptured uterus. The incidence of ruptured uterus was calculated to be 0.012%; eight (47%) of these occurred in patients with previous cesarean scars, while nine cases (52.9%) were grand multiparas (5 or more). In nine cases (52.9%), uterine rupture was associated with oxytocin use, and four patients (23.5%) were associated with prostaglandin E2 (PGE2) use. The ruptures occurred in the posterior uterine wall in one patient, the scar of a classical cesarean section in another, and in the lower segment in the remainder. Fetal heart abnormalities were observed in all cases in which the uterus ruptured during labor. Abdominal hysterectomy was performed in eight cases (47%). The remaining nine patients had suture repair, two with sterilization, and the other seven without sterilization. Six of these subsequently became pregnant, for a total of ten babies, all delivered by cesarean section. CONCLUSION: Even though rupture of the uterus was rare in our study, its occurrence should be suspected when there are sudden fetal heart abnormalities during labor or unexpected antepartum or postpartum hemorrhage. Suture repair should be considered whenever possible to maintain the patient's future fertility.     

Subsequent pregnancy following uterine artery embolization for interstitial pregnancy

Subsequent pregnancy following an interstitial pregnancy is rare. The risk of uterine rupture may be increased in this situation. Uterine selective embolization has been proposed as an effective treatment. However, no further pregnancy has ever been described after this method of management. We are reporting a case of subsequent pregnancy following interstitial pregnancy managed by embolization. The pregnancy was uneventful. A healthy male infant was delivered by C-section. This case supports the hypothesis that selective embolization for interstitial pregnancy may respect fertility. However, as actual risk of uterine rupture in subsequent pregnancies remains unknown, a C-section is advised.     

Spontaneous rupture of uterine vessels during pregnancy in a patient with previous endometriosis

Spontaneous rupture of the utero-ovarian vessels during pregnancy is a rare condition that can be life-threatening. Endometriosis is one of the factors associated with this complication of the pregnancy. Location of the pain as well as the course of this complication can simulate various diseases that must be dealt with. We describe the case associated with haemoperitoneum and hemorrhagic shock.     

Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion.

We present a case of interstitial pregnancy causing uterine cornual rupture during induction of prostaglandin midtrimester abortion. As the clinical and ultrasonographic diagnosis of advanced ectopic gestation may be difficult, the possibility of ectopic pregnancy should be considered in cases of unsuccessful attempts of induced abortion.     

Dislocated IUD and intrauterine ectopic pregnancy with uterine rupture.

A case of uterine rupture due to an ectopic pregnancy in the uterine fundus is presented. A Lippes Loop was found rotated in the uterine cavity. A possible relation between implantation and the dislocated intrauterine device is proposed.     

Spontaneous uterine venous rupture during pregnancy. Description of two cases and bibliographical review

Spontaneous uterine venous rupture is a very rare condition (1/10,000 pregnancies). The etiology is still unknown, and it is associated with an increased of venous pressure. The rupture especially occurs on third trimester. The most frequent site of the rupture is the broad ligament. Maternal mortality has decreased to 4% but the perinatal mortality rate is still as high as 31%. The presenting symptoms are commonly unspecific. Clinical presentations are usually hypovolemic shock signs with severe abdominal pain and reduction in hemoglobin levels. In view of these findings an exploratory laparotomy is usually necessary as well as the adequate blood and fluid replacement. Two cases of twin pregnancies on the third trimester with spontaneous uterine venous rupture are reported. Both cases have different evolution. In the first case the evolution was favorable. It wasn't necessary the vein suture because of the bleeding ended by compression. In the second case the diagnostic took place after the fetal death and it was required the vein suture. This rare condition has to be taken into account to de the differential diagnosis in a pregnant woman with severe abdominal pain.