Cases reported "Uterine Rupture"

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1/234. The effect of uterine rupture on fetal heart rate patterns.

    The high success rate of vaginal birth after cesarean section (VBAC) and its low association with complications has led to VBACs being attempted at all types of facilities, including birth centers. It must be kept in mind that unpredictable uterine rupture can occur and that uterine rupture necessitates emergency intervention. The only reported predictable feature of fetal heart rate patterns in response to uterine rupture is the sudden onset of fetal bradycardia. Fetal patterns are presented to illustrate this finding.
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2/234. uterine rupture after use of a prostaglandin E2 vaginal insert during vaginal birth after cesarean. A report of two cases.

    BACKGROUND: Prostaglandin E2, when used for cervical ripening, often initiates labor. Single dosing and ease of removal contribute to the common use of a commercially available prostaglandin E2 vaginal insert. We describe two cases of uterine rupture among 57 pregnancies undergoing attempted vaginal birth after cesarean section. CASES: Two cases of women attempting vaginal birth after a single low transverse cesarean section were treated with the insert either at 41 weeks, 4 days, or 39 weeks, 3 days, for postdatism or preeclampsia. Signs of uterine rupture included persistent suprapubic pain and repetitive fetal heart rate variable decelerations followed by bradycardia. Infant outcomes were favorable, and tears along the prior low transverse uterine scar were repaired without additional morbidity. CONCLUSION: This prostaglandin compound is not exempt from being associated directly or indirectly with uterine rupture and requires informed consent and continuous monitoring.
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3/234. Primary repair of cornual rupture occurring at 21 weeks gestation and successful pregnancy outcome.

    The successful delivery in a 31 year old woman at 33 weeks gestation is reported, after repair to a cornual rupture which occurred at 21 weeks gestation. The patient exhibited acute abdominal pain and pending shock. Emergency laparotomy showed a cornual rupture and an intrauterine vital fetus having intact amnion membrane. On the patient's family's insistence, primary repair for a cornual rupture was performed and preservation of the fetus attempted. Postoperatively, tocolytic agent with ritodrine hydrochloride was administered and close follow-up of the patient was uneventful. The patient had a smooth obstetric course until 33 weeks gestation when premature rupture of the membranes occurred, soon followed by the onset of labour. She underwent an elective Caesarean section and delivered a normal male fetus weighing 2140 g with Apgar scores at 1, 5 and 10 min of 6, 8, and 9 respectively. Because of this successful outcome, we suggest that primary repair for such an unusual patient should be accepted.
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4/234. uterine rupture after hysteroscopic metroplasty and labor induction. A case report.

    BACKGROUND: Hysteroscopic metroplasty has become the method of choice for the treatment of uterine septa. uterine perforation has been reported in about 1% of surgical hysteroscopic procedures. Ultrasound allows the detection of uterine lesions. CASE: A woman who conceived after complicated hysteroscopic metroplasty underwent emergency cesarean section because of uterine rupture during labor induced with prostaglandins (PGE2). An ultrasound scan performed two years later revealed a uterine lesion that corresponded to the myometrial tear reported at cesarean section. CONCLUSION: Complicated hysteroscopic metroplasty may promote acute uterine rupture during pregnancy and labor. Ultrasound is a useful tool for the detection of uterine lesions. If adequately considered, it might have allowed more rational management of labor in this case. PGE2 should never be used for induction of labor after complicated metroplasty.
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5/234. Spontaneous bilateral cornual uterine dehiscence early in the second trimester after bilateral laparoscopic salpingectomy and in-vitro fertilization: case report.

    A bilateral cornual uterine dehiscence is reported, which occurred 14 weeks after in-vitro fertilization (IVF) in a patient having a medical history of previous bilateral salpingectomy via laparoscopy. uterine rupture is a rare obstetric complication usually occurring during the third trimester of pregnancy within a uterus which has previously undergone an operation. Ectopic pregnancy is a well known complication of IVF. Post-salpingectomy cornual localization with rupture has also been published. Possible causes are discussed and the attention of the counselling physician is directed to the necessary awareness of such a complication in this high risk population. The reported case is an extreme rarity: a similar case has not been previously published in the literature.
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6/234. Extrauterine pregnancy resulting from early uterine rupture.

    BACKGROUND: Cesarean scar rupture of a gravid uterus in early gestation is rare. CASE: A 38-year-old woman, gravida 4, para 2-0-1-1, presented at 13 weeks' gestation with cramping and spotting. She had a history of two cesareans. Ultrasound and magnetic resonance imaging indicated probable uterine dehiscence and a viable extrauterine pregnancy. After embolization of the uterine arteries with subsequent fetal death, the subject had a hysterectomy. Intraoperatively, she had complete rupture of the lower uterine segment, but the pregnancy was enclosed within scar tissue between the uterus and bladder. placenta percreta was found by histologic examination. CONCLUSION: women with histories of cesareans might be at risk of early uterine rupture.
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7/234. uterine rupture in a multiparous woman during labor induction with oral misoprostol.

    A multigravida with gestational diabetes, mild pregnancy-induced hypertension and a previous curettage received four doses of misoprostol (100 microg) at three hourly intervals for induction of labor at term. Vaginal delivery of a live healthy baby occurred 1 h after the fourth dose. Hindwaters were bloodstained. Three hours later, she had excessive bleeding. Examination showed that the left lateral uterine wall had ruptured. She recovered after hysterectomy and blood transfusions.
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8/234. Spontaneous uterine rupture in the early third trimester after laparoscopically assisted myomectomy. A case report.

    BACKGROUND: The development of new and innovative laparoscopic instruments has allowed a greater number of gynecologic surgeons to laparoscopically remove large, intramural leiomyomata. Cases of both successful pregnancy and uterine rupture following laparoscopic myomectomy have been reported. This is the first report of uterine rupture in pregnancy following a laparoscopically assisted myomectomy. CASE: A 26-year-old, nulligravid woman underwent a laparoscopically assisted myomectomy. While the myomectomy had been performed laparoscopically, the uterine incision had been repaired in layers through a minilaparotomy incision. Two years later she became pregnant and, at 29 weeks' gestation, presented to labor and delivery with contractions and uterine tenderness. Over the next several hours, a nonreassuring fetal heart rate developed, and a cesarean section was performed, revealing hemoperitoneum and uterine rupture at the site of the prior myomectomy. CONCLUSION: The ultimate integrity of a uterine incision may depend not only on how the incision is repaired but also on how it is made. Laparoscopically created uterine incisions may not be as strong as those made at laparotomy, regardless of the method of closure.
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9/234. Bladder rupture associated with uterine rupture. A report of two cases occurring during vaginal birth after cesarean.

    BACKGROUND: uterine rupture occurs in < 1% of patients undergoing a trial of labor after cesarean section. Associated injury to adjacent organs within the maternal pelvis has likewise been very rarely reported. CASE: Two cases of posterior bladder wall rupture occurred in association with rupture of low transverse uterine incisions. CONCLUSION: Bladder rupture may be associated with uterine rupture during attempted vaginal birth after cesarean. The potential for bladder injury should be included in the patient's antepartum counseling.
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10/234. perinatal mortality and maternal mortality at the Provincial Hospital, Quang Ngai, South vietnam, 1967-1970.

    The perinatal mortality, maternal mortality, infant mortality rates, and the complications of delivery at the Provincial Hospital of Quang Ngai, South vietnam are described. The perinatal mortality is the only valid statistic available as the infant usually leaves the hospital within three days of delivery. knowledge pertaining to the 4th to 28th day after birth is scanty and there is insufficient knowledge about the first year of life. infant mortality is estimated at 277 per 1,000 live births. The perinatal mortality 64.6 per 1,000 live births, and maternal mortality, 106 per 10,000 live births are extremely high in contrast to Western countries. The high perinatal mortality is attributable to deaths during birth, the neonatal and immediate postnatal period. The high maternal mortality is primarily due to caesarean section, anemia, uterine rupture, toxemia, post-partum hemorrhage and puerperal infection.
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