Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6322-6329
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6322
Uterine rupture in patients with a history of multiple curettages: Two case reports
Mei-Fang Deng, Xiao-Di Zhang, Qun-Feng Zhang, Jue Liu
Mei-Fang Deng, Xiao-Di Zhang, Qun-Feng Zhang, Jue Liu, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanhua University, Hengyang 421001, Hunan Province, China
Author contributions: Deng MF reviewed the literature and contributed to writing the article; Zhang XD was the patient’s obstetrician, and contributed to extracting data; Zhang QF analyzed and interpreted the imaging findings; Liu J contributed to revising and editing the article; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patients for the publication of these reports and any accompanying images.
Conflict-of-interest statement: No conflicts of interest declared.
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: Jue Liu, MSc, Assistant Professor, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanhua University, No. 35 Jiefang Road, Hengyang 421001, Hunan Province, China. lj3457@163.com
Received: August 31, 2020
Peer-review started: August 31, 2020
First decision: September 13, 2020
Revised: September 26, 2020
Accepted: October 13, 2020
Article in press: October 13, 2020
Published online: December 26, 2020
Processing time: 110 Days and 1.4 Hours
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: Uterine rupture; Clinical manifestations; Early diagnosis; Abdominocentesis; Multiple curettages; Case report

Core Tip: With the full implementation of two-child policy in China, the prevalence of uterine rupture has shown an increasing trend. Atypical uterine rupture is easily misdiagnosed as other obstetric or surgical diseases. For atypical uterine rupture, abdominocentesis can be used to make a diagnosis. We present two atypical cases of uterine rupture, and explore risk factors, clinical manifestations, early diagnosis, prevention and treatment of uterine rupture.