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Delayed Presentation of Uterine Rupture Postpartum
Delayed Presentation of Uterine Rupture Postpartum
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Case notes
FIGURE 2
A 32-year-old G2P1 with a history of cesarean delivery had
Computed tomography scan of pelvis: transverse view
an uncomplicated vaginal delivery at term. Two days after
giving birth, she developed high-grade fever, tachycardia, hy-
potension, lower abdominal pain, and right flank pain.
Computed tomography (CT) scan at that time revealed
bladder wall thickening and a small amount of pelvic free fluid.
She was started on broad-spectrum antibiotics for suspected
pyelonephritis and sepsis. However, urine cultures were
FIGURE 1
Computed tomography scan of abdomen and pelvis:
coronal view
FIGURE 3
Uterine wall defect is seen in region of previous cesarean scar on right side Pelvic ultrasound
with pelvic collection tracking into right pararenal space.
Narasimhulu. Delayed presentation of uterine rupture. Am J Obstet Gynecol 2015.
FIGURE 4
Computed tomographyeguided percutaneous drainage of pelvic collection
for future pregnancies and was counseled on the risks of collections as an alternative to open surgery.3 Awareness of
pregnancy in the setting of an unrepaired uterine defect. the complication we describe may reduce delay in diagnosis
and facilitate appropriate management. -
Comments
When a vaginal birth is attempted after previous cesarean de-
livery, there is a 0.7% risk of uterine rupture.1 Uterine rupture REFERENCES
is usually diagnosed in labor or immediately postpartum 1. Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal
with serious consequences for the mother and baby especially outcomes associated with a trial of labor after prior cesarean delivery.
if surgical intervention is delayed, including severe fetal hyp- N Engl J Med 2004;351:2581-9.
oxia, fetal demise, massive postpartum hemorrhage, and 2. El-Kehdy GI, Ghanem JK, El-Rahi CC, et al. Rupture of uterine scar 3
maternal death. A delayed presentation of uterine rupture such weeks after vaginal birth after cesarean section (VBAC). J Matern Fetal
Neonatal Med 2006;19:371-3.
as the one we describe here is extremely rare but possible.2 3. Laganà D, Carrafiello G, Mangini M, et al. Image-guided percutaneous
Image-guided percutaneous drainage has been shown to be treatment of abdominal-pelvic abscesses: a 5-year experience. Radiol
feasible and effective in treating abdominal and pelvic Med 2008;113:999-1007.