Spontaneous Rupture of Unscarred Uterus in a Term Primagravida with Lethal Skeletal Dysplasia Fetus (Thanatophoric Dysplasia). A Case Report and Review of the Literature

Overview

Journal Int Med Case Rep J

Publisher Dove Medical Press

Specialty General Medicine

Date 2022 Oct 13

PMID 36225974

Authors

Ahmed Issak Hussein

Abdikarim Ali Omar

Hodan Abdi Hassan

Mohamed Mukhtar Kassim

Abdisalam Abdullahi Yusuf

Ahmed Adam Osman

Affiliations

Soon will be listed here.

Abstract

Background And Importance: Spontaneous uterine rupture, especially in an unscarred uterus, is a rare pregnancy complication that can cause severe morbidity and mortality in both the mother and the fetus. The vast majority of uterine ruptures occur in the presence of a previous uterine scar, most commonly from a previous cesarean delivery. To our knowledge, here we reported the first case of spontaneous rupture of unscarred uterus in a term primigravida secondary to lethal skeletal dysplasia fetus (Type 1 Thanatophoric dysplasia) faced by a practicing clinician in an underdeveloped country (Somalia) with a successful outcome.

Case Presentation: The patient was 24 yrs. Old Primagravida, at 40 weeks gestation by LMP, presented with abdominal pain and active vaginal bleeding; she did not receive antenatal care during pregnancy; after initial abdominal ultrasonography and vaginal examination, laparotomy was performed due to high suspicion of uterine rupture. After dead fresh fetal extraction, the uterine defect was repaired successfully, and the patient was discharged home in good condition after several days.

Conclusion: Through this case, we would like to highlight the urgent need to focus on and recognize the importance of receiving antenatal care in the community so that the burden of thousands of lives lost each year can be reduced.

References

Stembalska A, Dudarewicz L, Smigiel R . Lethal and life-limiting skeletal dysplasias: Selected prenatal issues. Adv Clin Exp Med. 2021; 30(6):641-647. DOI: 10.17219/acem/134166. View

Al-Zirqi I, Stray-Pedersen B, Forsen L, Daltveit A, Vangen S . Uterine rupture: trends over 40 years. BJOG. 2015; 123(5):780-7. DOI: 10.1111/1471-0528.13394. View

Tinelli A, Kosmas I, Carugno J, Carp H, Malvasi A, Cohen S . Uterine rupture during pregnancy: The URIDA (uterine rupture international data acquisition) study. Int J Gynaecol Obstet. 2021; 157(1):76-84. DOI: 10.1002/ijgo.13810. View

Getahun W, Solomon A, Kassie F, Kasaye H, Denekew H . Uterine rupture among mothers admitted for obstetrics care and associated factors in referral hospitals of Amhara regional state, institution-based cross-sectional study, Northern Ethiopia, 2013-2017. PLoS One. 2018; 13(12):e0208470. PMC: 6279034. DOI: 10.1371/journal.pone.0208470. View

Gibbins K, Weber T, Holmgren C, Porter T, Varner M, Manuck T . Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol. 2015; 213(3):382.e1-6. DOI: 10.1016/j.ajog.2015.05.048. View

Hofmeyr G, Say L, Gulmezoglu A . WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG. 2005; 112(9):1221-8. DOI: 10.1111/j.1471-0528.2005.00725.x. View

Hou J, Lee T, Wang S, Lai H, Mao S . Spontaneous uterine rupture at a non-cesarean section scar site caused by placenta percreta in the early second trimester of gestation: A case report. Taiwan J Obstet Gynecol. 2021; 60(4):784-786. DOI: 10.1016/j.tjog.2021.05.037. View

Jimah B, Mensah T, Ulzen-Appiah K, Sarkodie B, Anim D, Amoako E . Prenatal Diagnosis of Skeletal Dysplasia and Review of the Literature. Case Rep Obstet Gynecol. 2021; 2021:9940063. PMC: 8057870. DOI: 10.1155/2021/9940063. View

Heemskerk S, Ten Eikelder M, Janssen C . Uterine rupture in pregnancy after an intervention complicated by uterine perforation: Case report and systematic review of literature. Sex Reprod Healthc. 2019; 19:9-14. DOI: 10.1016/j.srhc.2018.11.001. View

10.

. CME Review Article. Pediatr Emerg Care. 2017; 33(12):792-793. DOI: 10.1097/01.pec.0000526609.89886.37. View

11.

Gueye M, Mbaye M, Ndiaye-Gueye M, Kane-Gueye S, Diouf A, Niang M . Spontaneous Uterine Rupture of an Unscarred Uterus before Labour. Case Rep Obstet Gynecol. 2012; 2012:598356. PMC: 3518087. DOI: 10.1155/2012/598356. View

12.

Uccella S, Cromi A, Bogani G, Zaffaroni E, Ghezzi F . Spontaneous prelabor uterine rupture in a primigravida: a case report and review of the literature. Am J Obstet Gynecol. 2011; 205(5):e6-8. DOI: 10.1016/j.ajog.2011.08.013. View

13.

Sweeten K, GRAVES W, Athanassiou A . Spontaneous rupture of the unscarred uterus. Am J Obstet Gynecol. 1995; 172(6):1851-5; discussion 1855-6. DOI: 10.1016/0002-9378(95)91422-6. View

14.

Zhang H, Liu H, Luo S, Gu W . Oxytocin use in trial of labor after cesarean and its relationship with risk of uterine rupture in women with one previous cesarean section: a meta-analysis of observational studies. BMC Pregnancy Childbirth. 2021; 21(1):11. PMC: 7786988. DOI: 10.1186/s12884-020-03440-7. View

15.

Chiossi G, DAmico R, Tramontano A, Sampogna V, Laghi V, Facchinetti F . Prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labor induction with PGE2: A systematic review and meta-analysis. PLoS One. 2021; 16(7):e0253957. PMC: 8259955. DOI: 10.1371/journal.pone.0253957. View

16.

Singh N, Singh U, Verma M . Ruptured bicornuate uterus mimicking ectopic pregnancy: A case report. J Obstet Gynaecol Res. 2012; 39(1):364-6. DOI: 10.1111/j.1447-0756.2012.01914.x. View

17.

Dimitrova D, Kastner A, Kastner A, Paping A, Henrich W, Braun T . Risk factors and outcomes associated with type of uterine rupture. Arch Gynecol Obstet. 2022; 306(6):1967-1977. PMC: 9633527. DOI: 10.1007/s00404-022-06452-0. View

18.

Nitzsche B, Dwiggins M, Catt S . Uterine rupture in a primigravid patient with an unscarred bicornuate uterus at term. Case Rep Womens Health. 2018; 15:1-2. PMC: 5842968. DOI: 10.1016/j.crwh.2017.03.004. View

19.

Ghahramani L, Moslemi S, Tahamtan M, Hashemizadeh M, Keshavarzi A . Antepartum Uterine Rupture Occurring at the Site of a Peviously Repaired Dilatation and Curettage-Induced Perforation: A Case Report. Bull Emerg Trauma. 2016; 1(2):96-8. PMC: 4771232. View

20.

Slaoui A, Mahtate M, Lazhar H, Lakhdar A, Baydada A, Kharbach A . Spontaneous uterine rupture revealing vascular Ehlers-Danlos syndrome: An uncommon case report. Int J Surg Case Rep. 2022; 92:106840. PMC: 8881606. DOI: 10.1016/j.ijscr.2022.106840. View