UTERINE RUPTURE – increased vigilance required

1. UTERINE RUPTURE – increased vigilance required Ruwaisa Aliyar, Jonathan Youngs, James Duffy, SujathaThamban and DilipVisvanathan Barts Health NHS Trust - Whipps Cross University Hospital – Whipps Cross Road, Leytonstone, London E11 1NR Case 2 A 28 year old, para 4, caucasian with 2 previous vaginal deliveries and a previous elective LSCS for twins had multiple visits with abdominal pain but was discharged as no concerns were found. She was initially booked for elective LSCS but opted to have a vaginal delivery. She presented at 40+2 weeks with reduced fetal movements and labour was induced. She had continuous CTG monitoring and was noted to have early decelerations. 12 hours after induction the CTG showed a fetal bradycardia and blood stained liquor was noted. A grade 1 LSCS was performed. On incision of the peritoneum, the fetal shoulder was protruding through a 3 cm gap in the uterus. A live male infant weighing 2956g was delivered and was resuscitated successfully. Mother and baby were discharged 5 days post-delivery. Background Results Conclusions Learning points from these case reviews are that uterine rupture may present most unexpectedly but clinicians must always be vigilant. Although VBAC is now widely encouraged, the significant increase in the potential risk of uterine rupture should be made clear. Induction of labour in patients with scarred uterus should be carried out with caution and close monitoring for early identification and prompt management of uterine rupture in order to prevent adverse maternal and fetal outcomes. Case 1 A 27 year old, para 2, African housewife who had two previous emergency LSCS for pre-eclampsia at 38 and 34 weeks was booked to have an elective LSCS at 39 weeks. Her pregnancy was uncomplicated until presentation to maternity triage at 32+2 weeks gestation with sudden onset of severe continuous abdominal pain, heavy fresh vaginal bleeding and a rigid abdomen. She was diagnosed with possible placental abruption and was taken to theatre immediately for an emergency LSCS. On entering the peritoneal cavity, the sac along with the fetus and placenta had been extruded from the scar. A female infant weighing 900g was delivered in poor condition with Apgar scores of 01,55,510. She was intubated and was transferred to SCBU. Uterine rupture is an uncommon but potentially catastrophic obstetric emergency. The incidence of scar rupture following VBAC is 9/1000 compared with 0.18/1000 with no previous caesarean section. We present two cases of uterine rupture that we managed in our department with positive outcomes. Methods Review of two cases of uterine ruptures presented to Whipps Cross University Hospital, London in September 2011. References Al-Zirqi I, Stray-Pedersen B, Forsén L, Vangen S. Uterine rupture after previous caesarean section. BJOG 2010;117:809–820. Al-Zirqi I, Stray-Pedersen B, Forsén L, Vangen S. Uterine rupture after previous caesarean section. BJOG 2010;117:809–820.