A CATASTROPHIC EVENT ASSOCIATED WITH RUPTURE OF THE UNSCARRED UTERUS AND PLACENTAL ABRUPTION

Abstract

Uterine rupture in patients with or without previous scar is a catastrophic event with a significant threat to the fetus and the mother. The rupture of the uterus without the previous scar is more threatening and associated with higher maternal and fetal morbidity and mortality.

We report a case here of a 35 years old gravida 4 with previous 3 normal deliveries who came in labour, at 36+ weeks and in active phase of the first stage of labour suddenly developed fetal bradycardia and bleeding, she was immediately shifted to operating room and emergency Cesarean was done intra operatively uterine rupture with complete placental abruption was found. The rupture was in the form of the T with vertical limb at the lower uterine segment and the horizontal limb of the T was involving the left broad ligament longitudinally. Left ureteric injury was suspected due to the position of the rupture which was confirmed and repaired by the urologist. The post op recovery of the patient was good but unfortunately the baby couldn't survive.

The PH of the cord blood was 6.9 which demonstrated the hypoxia of the baby due to the complete placental abruption.

The uterine rupture itself is associated with high morbidity and mortality but in the case under discussion, the fetal mortality was due to the additional contribution of the complete placental abruption.