Fahrni Anne-Claude, Salomon David, Zitiello Antonio, Feki Anis, Ali Nordine Ben
Department of Obstetrics and Gynecology, HFR Fribourg Hospital cantonal, 1708 Fribourg, Switzerland.
Case Rep Womens Health. 2020 Aug 15;28:e00249. doi: 10.1016/j.crwh.2020.e00249. eCollection 2020 Oct.
Uterine rupture is a rare event which can have severe obstetric consequences and most often occurs on a scarred uterus at the site of the scar. However, a uterine rupture can appear at another location. We report the case of a woman with a previous emergency caesarean section for spontaneous posterior uterine rupture which recurred at another site during her second pregnancy. She was admitted to the emergency room with acute abdominal pain and development of a pre-shock hemorrhagic state. Abdominal ultrasound showed abundant peritoneal fluid and a fetus without cardiac activity in an intact bulging amniotic fluid membrane. We performed an emergency laparotomy, which confirmed an intact amniotic sac in the abdominal cavity and showed a 7 cm transverse fundal uterine rupture beginning at the right angle, distant from the old known scars. In view of the high maternal and fetal morbidity, obstetricians should have a high suspicion of an antepartum uterine rupture, even at an early gestational age, in the event of acute abdominal pain over a scarred uterus.
子宫破裂是一种罕见事件，可产生严重的产科后果，最常发生于瘢痕子宫的瘢痕部位。然而，子宫破裂也可能出现在其他位置。我们报告一例曾因自发性子宫后壁破裂行急诊剖宫产的女性病例，其在第二次妊娠期间子宫破裂复发于另一部位。她因急性腹痛和休克前出血状态被收入急诊室。腹部超声显示腹腔内有大量腹腔积液，完整膨出的羊膜囊内胎儿无心跳。我们进行了急诊剖腹手术，术中证实腹腔内羊膜囊完整，可见子宫底部有一7厘米的横向破裂口，起于直角处，远离已知的旧瘢痕。鉴于母婴的高发病率，产科医生对于瘢痕子宫出现急性腹痛的情况，即使在孕早期，也应高度怀疑产前子宫破裂。
