Uterine rupture in patients with a history of multiple curettages: Two case reports

Abstract

Background: Uterine rupture is a serious obstetric emergency, a severe event, and a serious threat to maternal and fetal life. It is a rare and not well characterized by the fact that multiple operations of uterine cavities contribute to uterine rupture during pregnancy. Atypical uterine rupture is easily misdiagnosed as other obstetric or surgical diseases. In current guidelines, abdominocentesis is a contraindication for late pregnancy. Therefore, the cases presented in this report provide new ideas for clinical diagnosis and treatment of uterine rupture.

Case summary: Case 1, a 34-year-old woman (gravida 5, para 2), 32 wk and 4 d of gestation, presented with acute upper abdominal pain for 8 h with nausea and vomiting. Computed tomography (CT) revealed pelvic and abdominal effusion. We extracted 3 mL unclotted blood from her abdominal cavity. An emergency caesarean section was performed. A uterine rupture was found, and the fimbrial portion of the left fallopian tube was completely adhered to the rupture. The prognosis of both the mother and the infant was good. Case 2, a 39-year-old woman (gravida 10, para 1) at 34 wk and 3 d of gestation complained of persistent lower abdominal pain for half a day. Her vital signs were normal. CT revealed a high probability of pelvic and abdominal hemoperitoneum. We extracted 4 mL dark red blood without coagulation. An emergency laparotomy was performed. Uterine rupture was identified during the operation. Postoperative course in both the mother and infant was uneventful.

Conclusion: For pregnant women in the second or the third trimester with persistent abdominal pain, abdominal effusion, fetal distress and even fetal death, the possibility of uterine rupture should be highly suspected. CT can identify acute abdominal surgical or gynecological and obstetric diseases. Abdominocentesis is helpful for diagnosing and clarifying the nature of effusion, but its clinical value need to be confirmed by further clinical studies.

Keywords: Abdominocentesis; Case report; Clinical manifestations; Early diagnosis; Multiple curettages; Uterine rupture.