• Caesarean section
• Mid-trimester
• Uterine rupture

• Humans
• Female
• Uterine Rupture/epidemiology
• Uterine Rupture/etiology
• Pregnancy
• Retrospective Studies
• Adult
• China/epidemiology
• Infant, Newborn
• Cesarean Section/statistics & numerical data
• Risk Factors
• Incidence
• Postpartum Hemorrhage/epidemiology
• Postpartum Hemorrhage/etiology
• Pregnancy Trimester, Second
• Pregnancy Outcome/epidemiology
• Delivery, Obstetric/statistics & numerical data
• Trial of Labor
• Hysterectomy/statistics & numerical data

• 202112030366 the Hunan Provincial Health and Wellness Commission

• antenatal care
• emergency obstetric hysterectomy
• multidisciplinary approach
• multiparity
• unscarred uterus
• uterine rupture

• hysterectomy
• in vitro fertilization embryo transfer
• systemic lupus erythematosus
• uterine rupture

• Adult
• Female
• Humans
• Pregnancy
• Embryo Transfer/adverse effects
• Fertilization in Vitro/adverse effects
• Glucocorticoids
• Lupus Erythematosus, Systemic/complications
• Rupture, Spontaneous/complications
• Uterine Rupture/etiology
• Uterine Rupture/surgery
• Uterine Rupture/epidemiology
• Uterus

• Postpartum haemorrhage
• abdomino-pelvic compute tomography
• obstetric emergency
• peripartum hysterectomy
• unscarred uterine rupture

• Pregnancy
• Humans
• Female
• Postpartum Hemorrhage/diagnosis
• Postpartum Hemorrhage/etiology
• Postpartum Hemorrhage/therapy
• Uterine Rupture/diagnosis
• Uterine Rupture/therapy
• Retrospective Studies
• Delivery, Obstetric/adverse effects
• Hemoperitoneum

Uterine rupture is a fatal medical complication with a high mortality rate. Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures. Adenomyosis is a possible risk factor for uterine rupture. However, spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.

A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg. Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung, suggesting lung metastasis. The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules. Histologically, the uterus showed diffuse adenomyosis with glandular and stromal dissociation. Lung nodules were endometrioma with massive hemorrhage. Immunohistochemistry demonstrated that the tumor cells were positive for PAX8, ER, and PR expression, leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis. Following surgery, the patient remains in good condition without recurrence.

This is the first case of spontaneous uterine rupture due to adenomyosis in a non-gravida adolescent.

• Uterus
• Adenomyosis
• Malignancy
• Endometrioma
• Case report

• broad ligament hematoma
• case report
• grand multipara
• silent rupture uterus
• unscarred uterus

• déclenchement
• maturation cervicale
• travail

• cervical ripening
• induction
• labour

• Pregnancy
• Female
• Humans
• Systematic Reviews as Topic
• Labor, Obstetric
• Obstetrics
• Labor, Induced
• Oxytocin

Caesarean delivery (CD) is the commonest obstetric surgery and surgical intervention to save lives of the mother and/or the new-borns. Despite been accepted as safe procedure, caesarean delivery has an increased risk of adverse maternal and fetal outcomes. The rising rate of caesarean delivery has been a major public health concern worldwide and the consequences that come along with it urgently need to be assessed, especially in resource limited settings. We aimed to examine the relationship between first birth caesarean delivery and adverse maternal and perinatal outcomes in the second pregnancy among women who delivered at a tertiary hospital in Northern Tanzania.

A retrospective cohort study was conducted using maternally-linked data from Kilimanjaro Christian Medical Centre. All women who had singleton second delivery between the years 2011 to 2015 were studied. A total of 5,984 women with singleton second delivery were analysed. Multivariable log-binomial regression was used to determine the association between first caesarean delivery and maternal-perinatal outcomes in the second pregnancy.

Caesarean delivery in the first birth was associated with an increased risk of adverse maternal and perinatal outcomes in the second pregnancy. These included repeated CD (ARR 1.19; 95% CI: 1.05–1.34), pre/eclampsia (ARR 1.38; 95% CI: 1.06–1.78), gestational diabetes mellitus (ARR 2.80; 95% CI: 1.07–7.36), uterine rupture (ARR 1.56; CI: 1.05–2.32), peri-partum hysterectomy (ARR 2.28; CI: 1.04–5.02) and preterm birth (ARR 1.21; CI: 1.05–1.38).

Caesarean delivery in their first pregnancy had an increased risk of repeated caesarean delivery and other adverse maternal-perinatal outcomes in the following pregnancy. Findings from this study highlight the importance of devising regional specific measures to mitigate unnecessary primary caesarean delivery. Additionally, these findings may help both clinicians and women in deciding against or for trial of labor after previous caesarean delivery in an event of absent direct obstetric indication.

The online version contains supplementary material available at 10.1186/s12884-022-04719-7.

• Caesarean delivery
• Maternal -Perinatal outcomes
• Tanzania

Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications.

This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were reviewed retrospectively.

A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10000 births. Among the 41 cases, 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all cases, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcomes, such as fetal death. 24 (59.0%) of the ruptures occurred in anterior lower uterine segment. Changes in Fetal heart rate monitoring were the most reliable signs for rupture.

Incidence of uterine rupture in the study area, Shanghai, China was consistent with developed countries. Further improvements in obstetric care and enhanced collaboration with referring health facilities were needed to ensure maternal and perinatal safety.

The online version contains supplementary material available at 10.1186/s12884-022-04415-6.

• Cesarean section
• Maternal and neonatal outcome
• Risk factors
• Uterine rupture
• VBAC

Hemoperitoneum as a result of uterine rupture in a previously unscarred uterus is a rare entity to encounter and a potentially life-threatening condition. Ruptures can occur in a scarred uterus either spontaneously, due to operative manipulations, or with the use of uterotonic medications. In an unscarred uterus, spontaneous ruptures are known with high parity, use of oxytocin, and prolonged, neglected labor. Ruptures can be silent with no symptoms resulting in a delay in diagnosis and a near-miss situation. Here, we report the case of a 25-year-old young female who was referred to our tertiary care hospital in rural central India six hours after full-term vaginal delivery, which was followed by pain in the lower abdomen. She had no history of cesarean section, laparoscopic procedures, or surgical termination of pregnancy, which would have predisposed her uterus to rupture. She was severely pale on arrival, and a contrast-enhanced computerized tomography scan revealed rupture of the left side of the uterus with hemoperitoneum and a large pelvic hematoma. Because the patient was in hemorrhagic shock, she was immediately taken for laparotomy with simultaneous resuscitative measures and blood transfusion on flow. Extensive uterine rupture, extending through the cervix to the round ligament of the left side involving the left lateral uterine wall, with active bleeding from the site of the defect was confirmed. The hematoma was 10 × 10 cm in size and was evacuated, following which peripartum hysterectomy was done. The left ureter was traced and safeguarded while applying the clamp on Mackenrodt’s ligament. The patient recovered completely following the procedure. She was discharged on day 13 in stable condition. She is currently doing well on follow-up and is a good example of a maternal near miss. In this report, we emphasize that, even in the absence of any obvious risk factor, uterine rupture can occur during labor, and monitoring the vitals of patients in the immediate postpartum period is essential to detect and promptly manage this serious condition for preventing maternal mortality.

• Adult
• Cesarean Section
• Dinoprostone/pharmacology
• Female
• Humans
• Labor, Induced
• Pregnancy
• Prevalence
• Publication Bias
• Uterine Rupture/epidemiology
• Uterus/drug effects
• Uterus/pathology

• Cesarean section
• dilation and curettage
• risk factor
• unscarred uterus
• uterine rupture

Uterine rupture during pregnancy is a critical obstetric complication associated with maternal and fetal mortality and morbidity. The risk is increased in patients with a history of previous uterine surgery including cesarean section, myomectomy, salpingectomy, as well as uterine and placental anomalies and polyhydramnios. It can also occur spontaneously. We present a case of uterine rupture in the early third trimester in a woman who had undergone previous laparoscopic removal of the left fallopian tube due to sactosalpinx and laparotomic removal of left uterine horn due to ectopic pregnancy.

• Cornual resection
• Pregnancy
• Salpingectomy
• Third trimester
• Uterine rupture

• adenomyosis
• spontaneous uterine rupture
• twins

• Adenomyosis/complications
• Adult
• Cesarean Section
• Female
• Humans
• Live Birth
• Pregnancy
• Pregnancy Complications/etiology
• Pregnancy Trimester, Third
• Pregnancy, Twin
• Premature Birth/etiology
• Rupture, Spontaneous
• Uterine Rupture/etiology

Patient: Female, 31-year-old

Final Diagnosis: Uterine rupture secondary to placenta percreta

Symptoms: Acute abdomen

Medication: —

Clinical Procedure: Laparotomy and subtotal hysterectomy

Specialty: Obstetrics and Gynecology

• corticosteroids
• pregnancy complications
• risk factors
• uterine rupture

•

The risk of uterine rupture in a gravid, unscarred uterus is largely unknown.

When advising a pregnant patient who has previously had a cesarean section about the risks of trial of labor, it is important to explain the risk of uterine rupture. Subjective symptoms of abdominal pain or objective findings of non-reassuring fetal status and loss of fetal station are often indicative of this disease process, which most commonly is caused by a defect on the uterus from the cesarean delivery. Any uterine surgical intervention (myomectomy, for example) is the leading risk factor for uterine rupture. This case report presents a patient who had no such history. However, the maternal and fetal clinical status rapidly deteriorated and required emergency cesarean delivery, at which point a complete uterine rupture was diagnosed. Low suspicion for rare occurrences such as uterine rupture in an unscarred uterus can delay diagnosis, with increased likelihood of fetal and maternal morbidity and mortality.

• Advanced maternal age
• Cesarean hysterectomy
• External cephalic version
• Gravid
• Induction of labor
• Unscarred uterus
• Uterine rupture