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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (5): 769-773    DOI: 10.31083/j.ceog.2020.05.5361
Original Research Previous articles | Next articles
Analysis and discussion of high-risk factors in nine cases of uterine scar combined with complete uterine rupture
X.Y. Zhou1, K.X. Li2, X.M. Shu1, *()
1Department of Gynaecology and Obstetrics, the Affiliated Huai’an No.1 People's Hospital of Nanjing Medical University, Huai'an 223300, P.R. China
2Department of Gynaecology and Obstetrics, Huai' an Women and Children Health Hospital, Huai' an 223300, P.R. China
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Abstract  

Objective: This study aims to investigate the high-risk factors, clinical characteristics, and outcomes of complete uterine ruptures in patients with uterine scars. Methods: The data of nine patients with complete uterine ruptures, who were admitted to Huaian First People's Hospital from January 2015 to December 2017, were retrospectively analyzed. The general information of these patients and courses of treatment were summarized. Results: Among these nine patients with complete uterine ruptures, the induction of labor induced uterine rupture in four patients, placenta implantation induced uterine rupture in one patient, an unknown factor induced uterine rupture in one patient (with a history of artificial abortion), scar rupture occurred after laparoscopic cornual surgery in one patient, and the incision scar of a previous cesarean section ruptured after labor contractions in two patients. Rupture position: Rupture of the uterine body occurred in three patients, rupture of the uterine base occurred in one patient, rupture of the uterine horn occurred in one patient, and scar rupture at the previous incisions at the lower segment of the uterus occurred in four patients. The clinical manifestations were persistent abdominal pain in two patients, irregular lower abdominal pain in four patients, and no obvious abdominal pain in two patients. Six patients had complications with vaginal bleeding, while three patients had no vaginal bleeding. Seven patients underwent uterine rupture repair, while two patients underwent a subtotal hysterectomy. Among the five patients without induced labor, one patient had intrauterine fetal death, while the remaining four patients had good outcomes for newborns. Conclusion: Patients with a cesarean scar pregnancy, who underwent another pregnancy, suffer a high incidence of uterine rupture. The induction of labor with rivanol and misoprostol, placenta previa, multiple cesarean sections, multiple artificial abortions, and a history of gynecological uterine surgery are all high-risk factors for scar uterine pregnancy.

Key words:  Complete uterine rupture      Uterine scar      High-risk factor     
Submitted:  27 August 2019      Accepted:  04 November 2019      Published:  15 October 2020     
*Corresponding Author(s):  X.M. Shu     E-mail:  xiaomingshudr@163.com

Cite this article: 

X.Y. Zhou, K.X. Li, X.M. Shu. Analysis and discussion of high-risk factors in nine cases of uterine scar combined with complete uterine rupture. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 769-773.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.05.5361     OR     https://ceog.imrpress.com/EN/Y2020/V47/I5/769

Table 1  — The general information of nine patients with complete uterine rupture.
No. Age
(Years)
Gestational age (Weeks) Pregnancy history History of operation Time from the last operation
(Years)
Complications Regular prenatal Outside hospital referral
1 32 19 G4P2 Twice cesarean section 5 None None Yes
2 22 21 + 5 G2P1 Once cesarean section 1 None None Yes
3 28 31 + 5 G4P2 Once cesarean section, twice artificial abortion 2 Partial placenta previa None Yes
4 26 28 G3P2 Twice cesarean section 4 Placenta implantation None Yes
5 30 23 + 4 G6P1 Once cesarean section, four times artificial abortion 2 None None Surgical referral in our hospital
6 25 33 + 6 G2P1 Once cesarean section 9 Placenta implantation/
Pregnancy with cardiac disease/ Cardiac function grade II
None Yes
7 25 41 + 2 G6P1 Once cesarean section, four times artificial abortion 4 None None Yes
8 36 39 + 3 G4P2 Twice cesarean section, once artificial abortion 10 Severe preeclampsia None Yes
9 30 39 + 1 G2P0 Laparoscopic right fallopian tube resection and partial right uterine horn resection 1 None None Our hospital
Table 2  — The pathogenetic process of nine patients with complete uterine rupture.
No. Initial complaint Clinical signs and auxiliary examinations Location of uterine rupture Bleeding volume Intraoperative diagnosis Maternal and fetal outcomes
1 Mifepristone + misoprostol drug induces paroxysmal lower abdominal pain with massive vaginal bleeding after induction of labor Abdominal tenderness / rebound tenderness / muscle tension Longitudinal 8 cm rupture of the uterus extends to the cervical canal 2000 mL Complete uterine rupture Uterine repair
Hemorrhagic shock
2 Persistent lower abdominal pain with minor vaginal bleeding following misoprostol induction after failure of intracavitary induction of labor with rivanol Total abdominal tenderness rebound tenderness / mobile dullness positive Uterine original incision scar 9 cm completely split 1500 mL Complete uterine rupture Hemorrhagic shock / uterine rupture repair
3 After the induction of labor, rivanol showed irregular lower abdominal pain with a small amount of vaginal bleeding The tenderness of the uterine scar is obvious The longitudinal rupture of the uterus extends upward from the original scar to the bottom of the palace 1500 mL Complete uterine rupture Hemorrhagic shock / uterine rupture repair
4 Irregular lower abdominal pain with multiple vaginal bleeding after rivanol induced abortion Large uterine tension / tenderness in the lower uterus The rupture of the uterine scar was 1 cm long, and active bleeding occurred 5000 mL Placenta implantation, complete uterine rupture Hemorrhagic shock /DIC/ cardiopulmonary resuscitation / respiratory arrest / subtotal hysterectomy
5 Persistent pain around the umbilicus with nausea and vomiting Mid-abdominal tenderness and rebound pain The base of the uterus is about 4 × 3 cm 2500 mL Complete uterine rupture Hemorrhagic shock / uterine rupture repair
6 Painless vaginal bleeding for 1 hours Abdominal no tenderness and rebound tenderness Rupture of 5 × 5 cm area at the original scar of uterus 7000 mL Placenta implantation, complete uterine rupture Hemorrhagic shock / total hysterectomy
7 Menopause 41 + 4 weeks irregular lower abdominal pain 2 days, no vaginal bleeding The tenderness of the lower uterus is obvious The full-thickness rupture of the left margin of the uterus was long 2 cm without active bleeding 500 mL Complete uterine rupture Uterine repair
8 Menopause 39 + 3 weeks, persistent abdominal pain with vaginal bleeding The upper part of the uterus and the whole abdomen are tender, and the lower part of the uterus is not tender The left side of the uterus is split 10 m to the left lower cervix and the broad ligament is torn to the cervix 1500 mL Complete uterine rupture Uterine repair
Hemorrhagic shock
9 Asymptomatic No positive sign Rupture of hematoma on the right side of the original scar at 1 cm × 3 cm 500 mL Complete uterine rupture Uterine repair
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