Rupture of the uterus

We got a patient at 35 weeks’ gestational age, with a vertical scar below the umbilicus due to a previous caesarean section.

Although not completely term she had continuous contractions and the palpation of the abdomen was causing excruciating pains. There was rebound tenderness and signs of peritonism.

The urgent ultrasound has shown presence of blood in the peritoneal cavity, while the fetus was still alive.

Therefore we have decided for emergency C/S due to rupture of the uterus. We have given dexamethazone 8 mg intravenously and we have taken the patient to theater.

Rapidly we have extracted the child who was fortunately alive and well.

The problems started at this moment: in fact there was placenta accreta and it has been impossible to separate it from the uterus. 

On top of that the rupture was so massive that the uterus was completely destroyed and necrotic, making it impossible to think of a repair.

Because the mother was under spinal anesthesia we have tried to explain her the dire situation: it was impossible to repair the uterus, the rupture was still causing serious bleeding and also the placenta accreta was contributing to the blood loss.

She was totally confused and she cried loudly because the first C/S had been done too late and the child had died soon after delivery. The unfortunate event of the rupture of the uterus, with need of hysterectomy, was meaning for her the impossibility of getting a second child.

There was no time to waste because the bleeding was too much and she was collapsing. We have therefore decided to sedate her and to proceed for hysterectomy.

The operation went well and uneventfully.

The mother is now stable, awake and apparently very happy with her child, who is really bright and breast-feeding well.

Sometimes doctors are in front of really difficult decisions.

In my opinion there was no other option: at least that mother is alive and she has a baby.

Bro Beppe