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Nadir Bir Olgu: Ilk Gebelikte Spontan Uterus Rüptürü

Year 2014, Volume: 5 Issue: 10, 238 - 240, 01.10.2014

Abstract

Giriş: Gebeliğin çok nadir bir komplikasyonu olan spontan uterus
rüptürü hem fetus hem de anne için oldukça katastrofiktir. Bu
durum, uterus anomalileri, uterin skar dokusu varlığı, makrozomik
fetüs, sefalopelvik uyuşmazlık ve doğum esnasında indüksiyon
ajanları kullanılması gibi risk faktörleri ile ilişkilidir. Bu yazıda
oldukça nadir görülen, ilk gebelikte gelişen, travma öyküsü
olmayan skarsız bir uterus rüptürü vakasını tartışmayı amaçladık.
Olgu Sunumu: 22 yaşında ve 22 haftalık ilk gebeliği olan hasta
acil servise bayılma ve hafif dispne şikayetleri ile başvurdu.
Hastanın travma öyküsü yoktu. Fizik muayenesinde Glasgow
koma skoru 15, arteriyel tansiyonu 60/30mmHg ve nabız sayısı
110/dakika idi. Yapılan ilk abdominal ultrason sonucu normal
olarak değerlendirildi. Kadın hastalıkları ve doğum uzmanına
toplamda 2 defa konsülte edilen hastada fetal kalp atımlarının
normal olduğu ve obstetrik bir patoloji düşünülmediği bilgisi
alındı. 1000ml normal salin infüzyonuna rağmen hipotansiyonu
devam eden hastanın yapılan kontrol ultrasonunda batın
içerisinde serbest sıvı tespit edildi. Bunun üzerine genel cerrahi
tarafından tanısal amaçlı acil laparotomy uygulanan hastada
batın içerisinde önemli miktarda kanama olduğu ve fetüsün
peritoneal kavitede olduğu görüldü. Hasta operasyon sonrasında
iyileşip, post operatif 5. günde taburcu edilirken fetus kaybedildi.
Sonuç: Her ne kadar primigravidlerde çok nadir görülse de,
acil servis doktorları hemodinamik olarak unstabil olan gebe
hastalarda spontan uterus rüptürünü akla getirmelidirler.

References

  • Sweeten KM, Graves WK, Athanassiou A. Spontaneous rupture of the unscarred uterus. Am J Obstet Gynecol 1995; 172: 1851-5; discussion 1855-6. [CrossRef]
  • Langton J, Fishwick K, Kumar B, Nwosu EC. Spontaneous rupture of an unscarred gravid uterus at 32 weeks gestation. Hum Reprod 1997; 12: 2066-7.
  • Golan A, Sandbank O, Rubin A.Rupture of the pregnant uterus. Obstet Gynecol 1980; 56: 549-54.
  • Uccella S, Cromi A, Bogani G, Zaffaroni E, Ghezzi F. Spontaneous prelabor uterine rupture in a primigravida: a case report and review of the literature. Am J Obstet Gynecol 2011; 205: e6-8. [CrossRef]
  • Abbi M, Misra R. Rupture of uterus in a primigravida prior to onset of labor.Int J Fertil Womens Med 1997; 42: 418-20.
  • Ayres AW, Johnson TR, Hayashi R. Characteristics of fetal heart rate tracings prior to uterine rupture. Int J Gynaecol Obstet 2001; 74: 235-40. [CrossRef]
  • Mizutamari E, Honda T, Ohba T, Katabuchi H. Spontaneous rupture of an unscarred gravid uterus in a primigravid woman at 32 weeks of gestation. Case Rep Obstet Gynecol 2014; 2014: 209585. doi: 10.1155/2014/209585. Epub 2014 Jun 30. [CrossRef]
  • Hruska KM, Coughlin BF, Coggins AA, Wiczyk HP. MRI diagnosis of spontaneous uterine rupture of an unscarred uterus. Emerg Radiol 2006; 12: 186-8. [CrossRef]
  • Guèye M, Mbaye M, Ndiaye-Guèye MD, Kane-Guèye SM, Diouf AA, Niang MM et al. Spontaneous Uterine Rupture of an Unscarred Uterus before Labour. Case Rep Obstet Gynecol 2012; 2012: 598356.
  • Conturso R, Redaelli L, Pasini A, Tenore A. Spontaneous uterine rupture with amniotic sac protrusion at 28 weeks subsequent to previous hysteroscopic metroplasty. Eur J Obstet Gynecol Reprod Biol 2003; 107: 98-100. [CrossRef]

A Rare Case: Spontaneous Uterine Rupture in First Pregnancy

Year 2014, Volume: 5 Issue: 10, 238 - 240, 01.10.2014

Abstract

Introduction: Spontaneous uterine rupture is potentially catastrophic for both the mother and fetus. It is associated with risk factors, such as uterine abnormalities, uterine scar, macrosomic fetus, cephalopelvic disproportion, and use of uterotonic agents for induction of labor. We present a case of spontaneous rupture of an unscarred primigravid uterus, which is extremely rare. Case Report: A 22-year-old primigravida at 22 weeks presented to the emergency department with complaints of syncope and mild dyspnea. On her physical examination, she had a Glasgow coma scale of 15, tension arterial of 60/30 mmHg, and pulse rate of 110 beats/minute. Her first abdominal ultrasound was reported as normal. After consultation, the obstetrician reported that the fetus had normal fetal heart rate, and there had been no abnormality with the patient’s pregnancy. After intravenous infusion of 1000 ml saline, her hypotension still proceeded, and her second USG revealed free fluid in the abdomen. An emergency laparotomy was performed for a probable diagnosis of intra-abdominal hemorrhage and the fetus found floating freely in the peritoneal cavity. The patient recovered and discharged healthy 5 days after the operation, while the fetus could not survive.Conclusion: Although it is extremely rare in primigravidas, an emergency physician should consider spontaneous uterine rupture in pregnant patients with hemodynamic instability

References

  • Sweeten KM, Graves WK, Athanassiou A. Spontaneous rupture of the unscarred uterus. Am J Obstet Gynecol 1995; 172: 1851-5; discussion 1855-6. [CrossRef]
  • Langton J, Fishwick K, Kumar B, Nwosu EC. Spontaneous rupture of an unscarred gravid uterus at 32 weeks gestation. Hum Reprod 1997; 12: 2066-7.
  • Golan A, Sandbank O, Rubin A.Rupture of the pregnant uterus. Obstet Gynecol 1980; 56: 549-54.
  • Uccella S, Cromi A, Bogani G, Zaffaroni E, Ghezzi F. Spontaneous prelabor uterine rupture in a primigravida: a case report and review of the literature. Am J Obstet Gynecol 2011; 205: e6-8. [CrossRef]
  • Abbi M, Misra R. Rupture of uterus in a primigravida prior to onset of labor.Int J Fertil Womens Med 1997; 42: 418-20.
  • Ayres AW, Johnson TR, Hayashi R. Characteristics of fetal heart rate tracings prior to uterine rupture. Int J Gynaecol Obstet 2001; 74: 235-40. [CrossRef]
  • Mizutamari E, Honda T, Ohba T, Katabuchi H. Spontaneous rupture of an unscarred gravid uterus in a primigravid woman at 32 weeks of gestation. Case Rep Obstet Gynecol 2014; 2014: 209585. doi: 10.1155/2014/209585. Epub 2014 Jun 30. [CrossRef]
  • Hruska KM, Coughlin BF, Coggins AA, Wiczyk HP. MRI diagnosis of spontaneous uterine rupture of an unscarred uterus. Emerg Radiol 2006; 12: 186-8. [CrossRef]
  • Guèye M, Mbaye M, Ndiaye-Guèye MD, Kane-Guèye SM, Diouf AA, Niang MM et al. Spontaneous Uterine Rupture of an Unscarred Uterus before Labour. Case Rep Obstet Gynecol 2012; 2012: 598356.
  • Conturso R, Redaelli L, Pasini A, Tenore A. Spontaneous uterine rupture with amniotic sac protrusion at 28 weeks subsequent to previous hysteroscopic metroplasty. Eur J Obstet Gynecol Reprod Biol 2003; 107: 98-100. [CrossRef]
There are 10 citations in total.

Details

Other ID JA33UA76MC
Journal Section Case Report
Authors

Gökhan Aksel

Aslı Bilge Kanber Deniz This is me

Özlem Güneysel This is me

Publication Date October 1, 2014
Submission Date October 1, 2014
Published in Issue Year 2014 Volume: 5 Issue: 10

Cite

APA Aksel, G., Kanber Deniz, A. B., & Güneysel, Ö. (2014). A Rare Case: Spontaneous Uterine Rupture in First Pregnancy. Journal of Emergency Medicine Case Reports, 5(10), 238-240.
AMA Aksel G, Kanber Deniz AB, Güneysel Ö. A Rare Case: Spontaneous Uterine Rupture in First Pregnancy. Journal of Emergency Medicine Case Reports. October 2014;5(10):238-240.
Chicago Aksel, Gökhan, Aslı Bilge Kanber Deniz, and Özlem Güneysel. “A Rare Case: Spontaneous Uterine Rupture in First Pregnancy”. Journal of Emergency Medicine Case Reports 5, no. 10 (October 2014): 238-40.
EndNote Aksel G, Kanber Deniz AB, Güneysel Ö (October 1, 2014) A Rare Case: Spontaneous Uterine Rupture in First Pregnancy. Journal of Emergency Medicine Case Reports 5 10 238–240.
IEEE G. Aksel, A. B. Kanber Deniz, and Ö. Güneysel, “A Rare Case: Spontaneous Uterine Rupture in First Pregnancy”, Journal of Emergency Medicine Case Reports, vol. 5, no. 10, pp. 238–240, 2014.
ISNAD Aksel, Gökhan et al. “A Rare Case: Spontaneous Uterine Rupture in First Pregnancy”. Journal of Emergency Medicine Case Reports 5/10 (October 2014), 238-240.
JAMA Aksel G, Kanber Deniz AB, Güneysel Ö. A Rare Case: Spontaneous Uterine Rupture in First Pregnancy. Journal of Emergency Medicine Case Reports. 2014;5:238–240.
MLA Aksel, Gökhan et al. “A Rare Case: Spontaneous Uterine Rupture in First Pregnancy”. Journal of Emergency Medicine Case Reports, vol. 5, no. 10, 2014, pp. 238-40.
Vancouver Aksel G, Kanber Deniz AB, Güneysel Ö. A Rare Case: Spontaneous Uterine Rupture in First Pregnancy. Journal of Emergency Medicine Case Reports. 2014;5(10):238-40.