Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2020; 8(13): 2855-2861
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2855
Laparoscopic repair of uterine rupture following successful second vaginal birth after caesarean delivery: A case report
Yan-Qing Cai, Wei Liu, Hong Zhang, Xiao-Qing He, Jian Zhang
Yan-Qing Cai, Wei Liu, Hong Zhang, Xiao-Qing He, Jian Zhang, Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
Yan-Qing Cai, Wei Liu, Hong Zhang, Xiao-Qing He, Jian Zhang, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
Yan-Qing Cai, Wei Liu, Hong Zhang, Xiao-Qing He, Jian Zhang, Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China
Author contributions: Zhang J conceived of the study, participated in the surgery, supervised the study, and critically revised the manuscript; Cai YQ participated in the statistical analysis and wrote the manuscript; Liu W, He XQ, and Zhang H contributed to data and image collection; all authors read and approved the final version of the manuscript.
Supported by International Peace Maternal and Child Health Institute Clinical Research Program, No. YN201910; and Translational Medicine Cross Fund from Shanghai Jiao Tong University, No. YG2017QN38.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Zhang, MD, Chief Doctor, Professor, Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Road, Xuhui District, Shanghai 200030, China. zhangjian_sjtu@126.com
Received: March 12, 2020
Peer-review started: March 12, 2020
First decision: April 22, 2020
Revised: May 1, 2020
Accepted: June 18, 2020
Article in press: June 18, 2020
Published online: July 6, 2020
Processing time: 110 Days and 21.9 Hours
Abstract
BACKGROUND

With the increasing trend of vaginal birth after caesarean delivery (VBAC), evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering. Intrapartum uterine rupture is diagnosed in approximately one-fifth of all VBAC cases following successful vaginal delivery. To our knowledge, no report is available on the application of laparoscopy to repair postpartum uterine rupture after a successful second VBAC in China.

CASE SUMMARY

A 31-year-old woman (gravida 5, para 2) at 39 wk and 5 d of gestation was admitted to the hospital in labour. After a successful VBAC and observation for approximately 13 h, the patient complained of progressive abdominal pain. Given the symptoms, signs, and auxiliary examination results, intraperitoneal bleeding was considered. Because the patient was stable and ultrasound imaging was the only method available to assess the possibility of rupture, we recommended laparoscopy to clarify the diagnosis and for prompt laparoscopic uterine repair or exploratory laparotomy if necessary. Operative findings included transverse uterine scar rupture at the lower uterine segment of approximately 5.0 cm in length and 800 mL of intraoperative pelvic haemoperitoneum. Finally, she successfully underwent laparoscopic repair of uterine rupture and recovered very well according to three-dimensional magnetic resonance imaging at 42 d postpartum.

CONCLUSION

Routine postpartum intrauterine exploration is not beneficial to the mother and may even increase the risk of rupture. This case highlights a laparoscopic approach for repairing uterine rupture in the immediate postpartum period.

Keywords: Uterine rupture; Laparoscopic repair; Vaginal birth after caesarean section; Postpartum period; Grand multiparity; Case report

Core tip: With the advent of the two-child policy, the number of vaginal birth after caesarean delivery (VBAC) cases has markedly increased in China. Evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering. In addition, if uterine rupture is identified after successful vaginal delivery but vital signs are stable, minimally invasive methods can be used to diagnose and repair uterine rupture. This case highlights a laparoscopic approach for repairing uterine rupture in the immediate postpartum period, and we hope that this technique will have an important clinical role in effectively reducing misdiagnoses of maternal injury and facilitating a quick recovery.