Ibrahim Shereen, Drymiotou Stefanie, Hegab Khadiga, Sideris Michail, Okba Mohamed
North Middlesex University Hospital, Obstetrics and Gynaecology Department, UK.
Doncaster and Bassetlaw Teaching Hospital, Obstetrics and Gynaecology Department, UK.
Ann Med Surg (Lond). 2020 Dec 25;61:145-147. doi: 10.1016/j.amsu.2020.12.020. eCollection 2021 Jan.
Spontaneous uterine rupture before onset of labour is extremely rare. This is even more so in the second trimester of pregnancy, in nulliparous women and in the absence of myometrial surgery. The initial presentation of this potentially catastrophic event may be non-specific, with upper or lower abdominal discomfort, vague gastrointestinal or urinary symptoms preceding rapid deterioration.
This case report demonstrates that a high index of suspicion, rapid diagnosis aided by imaging modalities and immediate surgical intervention are crucial steps in successful management. A postulated etiology in our patient is that of an upper scar from a previous uterine curettage with abnormal placentation predisposing to spontaneous rupture.
A case of spontaneous uterine rupture at 16 week's gestation in a multiparous, 32 year old patient with no history of myometrial surgery. She had presented with lower abdominal discomfort, progressing to severe pain with hypotension and tachycardia. An urgent ultrasound pelvis showed a live fetus, free intra-peritoneal fluid with blood clots. An emergency laparotomy performed revealed 2 L of hemoperitoneum, with the fetus intact in the amniotic sac. The uterine fundal rupture was successfully repaired.
Despite the gestation, in women presenting with symptoms and signs suggestive of acute abdomen and hemodynamic instability, prompt resuscitation must be instituted, and a high index of suspicion for rupture must be suspected.
临产前自发性子宫破裂极为罕见。在妊娠中期、初产妇且无子宫肌层手术史的情况下更是如此。这一潜在灾难性事件的初始表现可能不具特异性，在迅速恶化之前会出现上腹部或下腹部不适、模糊的胃肠道或泌尿系统症状。
本病例报告表明，高度的怀疑指数、借助影像学手段的快速诊断以及立即进行手术干预是成功治疗的关键步骤。我们患者的一种推测病因是既往子宫刮宫术留下的上部瘢痕合并异常胎盘植入，易引发自发性破裂。
一名32岁经产妇，无子宫肌层手术史，妊娠16周时发生自发性子宫破裂。她最初表现为下腹部不适，随后发展为伴有低血压和心动过速的剧痛。紧急盆腔超声检查显示有存活胎儿、腹腔内有游离液体及血凝块。急诊剖腹探查发现腹腔积血2升，胎儿完整地位于羊膜囊内。子宫底部破裂成功修复。
尽管处于妊娠期，但对于出现提示急腹症和血流动力学不稳定症状及体征的女性，必须立即进行复苏，并高度怀疑有破裂情况。
