A Rare Case of Posterior Uterine Wall Rupture Complicated by Massive Transfusion and Disseminated Intravascular Coagulation
Uterine rupture is a potentially catastrophic complication of caesarean section. Atypical rupture occurring away from the previous scar site is extremely rare with less than 20 cases reported in the literature. A 38-yearold presented at 37 weeks gestation with maternal collapse. Emergency caesarean section revealed foetal loss and a posterior uterine rupture with an intact lower uterine segment. A subtotal hysterectomy was performed. Disseminated intravascular coagulopathy (DIC) developed rapidly and required massive transfusion. The patient was discharged home twelve days later. Posterior uterine rupture is rare and requires prompt surgical intervention and multi-disciplinary teamwork to prevent serious maternal morbidity.
Uterine rupture is a potentially catastrophic complication of previous caesarean section. It is associated with significant maternal and neonatal morbidity. It is often attributable to structural compromise of the uterine scar following caesarean section1. Atypical rupture occurring away from the previous scar site is extremely rare, with only a handful of cases documented in the literature2. The majority of the cases have occurred with attempted VBAC and augmented labour. We present a rare case of posterior uterine rupture occurring in a patient booked for elective caesarean section. The case required massive transfusion and was complicated by disseminated intravascular coagulation.
A 38-year-old gravida 3, para 2, presented to hospital at 37 weeks’ gestation with maternal collapse. She had two previous lower segment caesarean sections, one for foetal distress and the second as an elective. She had a history of sickle cell trait and her antenatal course had been uncomplicated. There were no identified risk factors for uterine rupture, such as previous myomectomy or connective tissue disorders. She was booked for an elective LSCS at 39 weeks. The patient presented with acute abdominal pain, hypotension and antepartum hemorrhage estimated at 500mls, without preceding contractions. She had a central pulse of 130, a systolic blood pressure of 60mmHg and a GCS of 10. A diagnosis of uterine rupture was made based on palpable foetal parts in the abdomen. She was taken immediately to theatre for emergency LSCS.
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