Critical Care Obstetrics and Gynecology

An Unusual Presentation of Rupture in an Unscarred Uterus

This paper presents a case of a 36-year old female who experienced a rupture of her unscarred uterus during delivery of her child. She was induced with prostaglandins at 37 weeks for reduced fetal movements and her labor was augmented with oxytocin. A kiwi assisted vaginal delivery was performed in view of 2nd stage fetal bradycardia. A few hours post-delivery, she complained of chest pain. She was noted to be tachycardia and hypotensive. On examination, she had a tender abdomen with rebound and guarding. Investigations revealed that she had a 4g/dL drop in haemoglobin and a CT scan was suggestive of a uterine rupture. She underwent an exploratory laparotomy and was confirmed to have a posterior uterine wall rupture, which was repaired. She recovered well and was discharged on the 3rd post-operative day. Serious morbidity and mortality was likely avoided in view of a high index of suspicion. Induction and augmentation of labor have been known to predispose to uterine rupture. Fetal bradycardia may be the only sign of an intrapartum uterine rupture, hence the use of continuous electronic fetal monitoring is vital when these agents are being used.

Author(s):

Shilla Mariah Yussof and Crystal Chin Hsuan

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