SUCCESSFUL PREGNANCY AND DELIVERY IN PATIENT WITH PREVIOUS CORPORAL UTERINE INCISION AND UTERINE RUPTURE
Keywords:
Uterine rupture, Corporal cesarean sectionAbstract
Uterine rupture is a rare complication of pregnancy and delivery, which carries a high risk of perinatal morbidity and mortality for both, the mother and fetus. Nowadays, in developed countries, it is observed mainly in pregnant women after surgical interventions on the uterus, especially cesarean section. An incision in the uterine body during cesarean section significantly increases the risk of uterine rupture in subsequent pregnancies. In these cases, stricter monitoring of the pregnancy is indicated in subsequent pregnancies, as well as earlier delivery in order to prevent repeated uterine rupture. We present a rare case of a patient with a successful pregnancy and delivery after one termination of pregnancy by corporal hysterotomy and uterine rupture in a subsequent pregnancy. In the first pregnancy, due to fetal anomaly, the patient underwent laparotomy with evacuation of the fetus and its appendages through a corporal incision of the uterus. The patient's next pregnancy ended with a planned low segment transverse cesarean section without complications. In the third pregnancy, the patient was admitted to the hospital as an emergency with evidence of acute abdomen and hemodynamic instability at 32 weeks of gestation. It was assumed that it was a case of placental abruption and an emergency surgical intervention was undertaken. During the operation, a longitudinal rupture of the uterus along the anterior uterine wall in the area of the previous scar, hemoperitoneum and a dead fetus in the abdominal cavity were found. The uterus was preserved due to the patient's desire for a second child. About 13-14 months after this event, the patient became pregnant again. The pregnancy proceeded without medical complications, but with a high level of anxiety on the part of the pregnant woman. At 34 weeks of gestation, planned cesarean section was performed. A live premature fetus weighing 2000 g was born. During the cesarean section, a severely thinned uterine wall was found in the area of the previous longitudinal incisions, but there was no evidence of uterine dehiscence or rupture. This time, the uterus was also restored, and the postpartum period proceeded without complications. The prognosis of pregnancies after a classic cesarean section and/or uterine rupture is generally good. Perhaps the most important aspect in the follow-up of these pregnancies is determining the time for delivery. Premature births are more common, but they are mostly iatrogenic and are due to the high level of anxiety of both the pregnant woman and the medical specialists. It is necessary to carefully monitor these pregnant women, especially in the direction of the appearance of symptoms of uterine rupture, and in the presence of such, urgent hospitalization and delivery in a hospital with readiness to meet this complication and the possibility of caring for a premature newborn is required.
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