Balzira N. Bishekova
Asfendiyarov Kazakh National Medical University, KazakhstanPresentation Title:
Spontaneous uterine rupture in a multiparous woman without an uterus scar
Abstract
Uterine rupture is a critical obstetric complication occurring during pregnancy or childbirth, characterized by high maternal and perinatal morbidity and mortality rates, primarily due to internal bleeding, antenatal/intrapartum fetal death, hemorrhagic/pain shock, cardiac arrest, and disseminated intravascular coagulation.
In recent decades, due to expanded indications for operative delivery, a uterine scar has become a primary risk factor for uterine rupture. Instances of spontaneous rupture at the scar site, in association with placenta accreta spectrum (PAS), significantly increasead verse outcomes for both mother and fetus.
Spontaneous uterine rupture during pregnancy is quite rare. The risk group includes multiparous women and those with a history of intrauterine manipulations such as dilatation and curettage (D&C) or uterine septum resection. Cases of uterine rupture without commonly accepted risk factors, regardless of parity or gestational age, have been described in the literature.
This article presents a clinical case of a complete uterine rupture occurring outside a medical facility at 25 weeks of pregnancy in a multiparous woman with a complicated obstetric-gynecological history, without a uterine scar. This was accompanied by severe hemorrhagic shock, cardiac arrest, and antenatal fetal demise. High-quality specialized care resulted in a favorable outcome for the mother.
Conclusion: Thus, the high parity of pregnancies and childbirths (4 urgent deliveries and 2 spontaneous abortions), neglect of the interconception interval, and incongruence of the uterine muscle apparatus (twice curettage of the uterine cavity) led to an abnormality in placental attachment (placenta percreta) and collectively caused uterine rupture in a multiparous woman without a uterine scar, as confirmed by the results of the histological examination.
Biography
Balzira N. Bishekova, MD, PhD, Professor of the Department of Obstetrics and Gynecology of the Kazakh National Medical University of Republic of Kazakhstan.
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