Spontaneous prelabor uterine rupture in a primigravida: a case report and review of the literature

A rare case of prelabor uterine rupture in a primigravida was reported. A woman with a history of uterine perforation during hysteroscopy became pregnant after donor oocyte in vitro fertilization. To provide more insight into the possible risk factors for prelabor uterine rupture in primigravidae, a literature review was performed.     

Spontaneous uterine rupture with placenta percreta: a case report

A case of spontaneous uterine rupture resulting from placenta percreta is described. The patient was treated by cesarean section and abdominal hysterectomy. The etiology, clinical features and management of this rare complication of pregnancy are briefly discussed.     

Spontaneous uterine rupture of an unscarred uterus during labor: case report and review of the literature

Uterine rupture during labor is a serious and uncommon obstetrical complication that can lead to severe prognosis for the mother and her child if not immediately diagnosed and treated. Most spontaneous uterine ruptures occur during labor in parturients with a scarred uterus and are much rarer on an unscarred uterus. We report the case of a uterine rupture on unscarred uterus to a 32 year-old woman after a labor induced by intravaginal prostaglandin and intravenous ocytocine injection. Our management is compared with the data from literature.     

Intravenous uterine leiomyomatosis with diffuse dissemination in pelvic cavity. Case report and literature review

Diffuse uterine leiomyomatosis is a rare benign entity in gynecology, with only 30 worldwide reports. Its most frequent complications are dissemination into vena cava, cardiac obstruction (right cavities and valves), and diffuse pelvic invasion. We report a case of a 40 years old female with history of pelvic mass resection. During surgery it was found a large abdominal-pelvic mass diffusely invading uterine body, and round and infundibulum-pelvic ligaments. This mass extends itself out of pelvis until aorto-abdominal bifurcation, and has gummatous, elastic, and highly bleeding consistency. Histopathologic report was intravenous leiomyomatosis with benign smooth muscular fibers infiltrating adjacent structures. Its origin was uterine tissue, but it invades, adjacently, all reproductive annexes deforming them anatomy. Its infiltrative quality confers a technical difficulty to surgeon, so he or she will need a multidisciplinary team to establish its treatment.     

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.     

Spontaneous subserosal venous rupture overlying a uterine leiomyoma. A case report

BACKGROUND: Patient age, parity and leiomyoma size are considered risks for venous rupture overlying a leiomyoma. CASE: A 28-year-old woman presented with abdominal pain and decreasing hematocrit from spontaneous rupture of a uterine leiomyoma vein. CONCLUSION: Congestion of a vein overlying a leiomyoma, irrespective of the patient's age or parity or size of the leiomyoma, is a risk factor for rupture.     

Expectant management of a herniated amniotic sac presenting as silent uterine rupture: a case report and literature review

Foetal membranes bulging into the abdominal cavity is a unique initial manifestation of silent or complete uterine rupture during pregnancy. Since silent uterine rupture has potential risk for complete uterine rupture, which leads to acute life-threatening complications for both the mother and baby, it is difficult to determine whether to manage expectantly or surgically, including repair of the uterine wall or termination of the pregnancy, especially in the early second trimester. We present here a case of a herniated amniotic sac with overstretched uterine wall of the fundus presenting as silent uterine rupture, which was incidentally detected on routine ultrasonography at 18 weeks' gestation in a 38-year-old primigravida with a history of myomectomy for diffuse uterine leiomyomatosis. Magnetic resonance imaging examination revealed that the myometrium thickness was fully maintained at the site of the foetal membranes ballooning. The pregnancy was therefore managed expectantly and continued to successful delivery at 30 weeks' gestation. The precise assessment of the uterine wall may be essential to manage a herniated amniotic sac presenting as silent uterine rupture and to optimise the outcome of the pregnancy. We review all cases of a herniated amniotic sac out of focally overstretched uterine wall before 34 weeks' gestation.     

Prenatal drainage of fetal urinoma with polyhydramnios: a case report and literature review

The appearance of fetal urinoma is rare in prenatal care, especially when associated with polyhydramnions. Many previous reports have concluded that the visualization of a prenatal urinoma is probably a sign of underlying renal dysplasia or poor function. Thus, the management of the reported cases, conservative treatment or uniroma drainage, has not been unified. In this paper, we present two cases of prenatally detected urinoma with prenatal drainage to improve the prognosis.     

Spontaneous hepatic rupture of pregnancy. A report of four cases and medical literature review

The spontaneous liver rupture associated with preeclampsia is a potential life threatening condition that requires a multidisciplinary team approach. There are near 200 cases reported in the world literature. This paper presents four cases of liver rupture associated with preeclampsia, three of which were consecutive with only two days apart, describing the clinical features and the therapeutic approaches. We also discussed about the mortality, which occurred in one of our cases, and perinatal mortality that affected one newborn and another one had neonatal encephalopathy secuelae. Three of the cases were managed in a surgical manner, one of them also with selective hepatic artery embolization meanwhile another one received conservative management. It is important to suspect this pathology in the preeclamptic patient, especially if she develops HELLP syndrome, in order to establish opportune diagnosis and treatment with a team including the intensive care, surgery and obstetrical staff.     

Pregnancy after uterine rupture: a report of 5 cases and a review of the literature

Management and outcome of 5 cases of pregnancy after uterine rupture are discussed. All women in these cases were delivered by cesarean delivery and no repeat ruptures occurred. After reviewing the literature, it is concluded that women with a previous uterine rupture have a favorable outcome in a subsequent pregnancy. With a rupture in a lower segment scar, an elective cesarean delivery should be performed before labor starts after assessing fetal lung maturity or administration of corticosteroids. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the risk associated with a subsequent pregnancy after a previous uterine rupture, summarize the complications of uterine rupture during a subsequent pregnancy, and to list the treatment plans for a patient in a subsequent pregnancy after uterine rupture.     

Deep venous thrombosis in a patient with large uterine myomata. Case report

A 42-year-old woman was admitted with a painful swelling of the left lower limb. Computed tomography revealed an inhomogenous uterine enlargement due to multiple myomata producing a thrombotic occlusion of the left iliac veins. Surgical treatment consisted of isolated hysterectomy. During the same operation, transfemoral thrombectomy and stent implantation in the iliac vein were performed. Hysto-logic examination revealed numerous leiomyomata as well as an endometriosis. The patient recovered well and is pain-free six months after surgery. The deep venous system is still patent at follow-up. Uterine myomata rarely cause acute iliac vein thrombosis due to direct compression. This case represents an example of successful therapy using an interdisciplinary approach.     

The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis

Fibroids may give rise to specific obstetrical complications such as pain due to degeneration, fetal malpresentation, or placenta previa. For all these reasons, surgical resection of the fibroid may be indicated before a pregnancy is pursued. The occurrence of a uterine rupture is a rare but severe complication of myomectomy. This study seeks to review the risk of uterine rupture during pregnancy and/or labor after laparoscopic myomectomy in comparison with laparotomic myomectomy. A systematic search of the literature through search strategies in MEDLINE (PubMed) and Embase (Embase.com) from January 1970 up to March 2013 was performed. We used the following MeSH terms and free text words: gynecologic surgical procedures, gynecologic surgery, leiomyoma, fibromyoma, fibroids, myoma, uterine tumors, and pregnancy complication. Our data show that the risk of uterine rupture during labor and delivery is low (0.75 %). Compared with traditional open myomectomy, the risk of uterine rupture during pregnancy is not significantly higher after a laparoscopic approach (P?=?0.119). More elective cesarean sections are performed after laparoscopic myomectomy compared with the conventional open technique (P?=?0.001). Our conclusions are supported by statistical pooling of observational studies of generally low methodological quality. The risk of uterine rupture after myomectomy is low (0.75 %). The available evidence in the literature does no allow discouraging attempts for childbirth per viam naturalem after previous myomectomy, regardless of the technique used. Randomized studies are needed before definitive evidence-based recommendations can be given.     

Spontaneous rupture of utero-ovarian vessels in postpartal period: a case report and review of the literature

Spontaneous rupture of utero-ovarian veins occurring during pregnancy or the peripartal period is generally considered to be a medical curiosity (approximately 100 reported cases) rarely mentioned in obstetric textbooks. It is nevertheless a dramatic cause of maternal and /or fetal mortality. The available statistics are the following: 60% of the cases are directly related to labor and 50% occur in primiparas; when the rupture is associated with labor, mortality is 40%. Occurring outside of labor, mortality rate is approximatively 10%. The perinatal mortality remains high at 30%; in 75% of the cases, the broad ligament is the site of rupture (in many cases, the site of rupture is not found, at laparotomy or autopsy). We report the case of a patient who developed ovarian vein rupture on the 3rd postpartum day.     

Primary non-Hodgkin lymphoma of the uterine corpus. Case report and review of the literature

We report a case of primary nonHodgkin lymphoma (NHL) of the uterine corpus, diagnosed by endometrial biopsy, in a 60-year-old patient suffering from uterine bleeding. Pathological analysis had concluded to diffuse large B-cell lymphoma. Further staging had not revealed other nodal or extranodal localization (Ann Arbor stage IE) and there were no signs of recurrence during follow-up. Therefore, the diagnostic criteria for true primary NHL of the uterine corpus were met. This localization is extremely rare since only six cases have previously been published. The patient was successfully treated by an immunochemotherapy combining rituximab-CHOP and rituximab-VCAP. After 28 months of follow-up, she is free from the disease. A review of the literature regarding these exceptional tumors is undertaken.     

Spontaneous rupture of the renal pelvis during pregnancy: a case report and review of the literature

We report a case with spontaneous rupture of the renal pelvis during pregnancy. A 34-year-old Japanese woman was referred at 20 weeks' gestation because of sudden severe right flank pain. She had severe colic pain radiating to the right lower abdomen with percussion tenderness at the right costovertebral angle and was initially suspected to have renal/ureteral calculi. Ultrasonography and intravenous pyelography showed urine extravasating from the renal pelvis, indicating rupture of the right renal pelvis. Immediately following the insertion of a double-J indwelling catheter, her symptoms and perirenal extravasation ceased. She had no further urological problems during pregnancy and a male infant was delivered at 41 weeks' gestation. Cases with spontaneous rupture of the renal pelvis in pregnancy are reviewed.