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Incidental Finding Of Uterine Rupture After Successful VBAC
Abstract Number: S-51
Abstract Type: Case Report/Case Series
Uterine rupture is a known, potentially life-threatening complication for mother and child during TOLAC, with an incidence of 0.7-1.8%1. Risk factors include previous C-section(s), labor augmentation, and multiparity1. Predictors of success include previous SVD and previous low transverse incision1. Failed TOLAC itself carries an increased morbidity2.
Uterine rupture can be hallmarked by several signs and symptoms including abdominal pain, vaginal bleeding, signs of fetal distress, cessation of uterine contractions, and hypovolemic shock.
We describe a 37yo G4P4004 woman who after successful VBAC, was taken for elective tubal ligation and found to have an unknown 10cm uterine rupture.
A 37yo, G4P3003 presented to L&D at 37w6 in active labor. Antenatal course was complicated by GDMA1 and AMA. She had two previous SVD’s followed by C-section due to placenta previa. VBAC was planned for this pregnancy followed by surgical sterilization.
Upon admission, an epidural was placed. Her membranes were artificially ruptured. An IUPC was placed to monitor contractions. Oxytocin was used to augment labor. She delivered a viable infant, APGAR’s 8/9 and weight 3240g.
She presented for tubal ligation 12hrs later. Her epidural was bolused. Good surgical anesthesia was noted, but general anesthesia was induced due to her extreme anxiety. After incision, old blood was noted. The incision was extended and clot was seen on the omentum. A 10cm rupture of the uterus was noted at the previous hysterotomy. The rupture was repaired and tubal ligation completed. EBL was 800cc. She was extubated in the OR. The remainder of her postpartum care was unremarkable.
While uterine rupture is life-threatening, it is usually accompanied by clinical manifestations that alert caregivers to impending disaster. None of these were noted. Prenatal ultrasounds showed normal anatomy and a posterior placenta. She did not report abdominal pain. No vaginal bleeding was noted. Fetal tracing was reassuring throughout labor. The IUPC documented no change in contractions and maternal hemodynamics were stable.
This patient’s insidious rupture could potentially represent a dangerous situation. Her condition may have gone undiagnosed if not for her elective surgery. Rebleeding after discharge could have been associated with a much worse outcome.
1.) ACOG Practice Bulletin. 116; 450-463
2.) Am J Obstet Gynecol. 184; 1365-1373