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Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Refer to the copyright information in the article for licensing details. Free full text in Europe PMC. Spontaneous uterine rupture in an unscarred uterus is very rare. It is found to be rarer after in-vitro fertilization. It is associated with significant morbidity and mortality if not diagnosed and treated promptly. Thirty three years female with twin pregnancy following in-vitro fertilization after 11 years of marriage presented to emergency department with lower abdominal pain at 36 weeks 3 days of gestation and was planned for emergency caesarean section for precious twin pregnancy in labour. She was vitally stable and on palpation of abdomen, there was generalized tenderness along with guarding. All the investigations were within normal limits. The babies were extracted with a lower uterine segment incision. First twin cried immediately after birth while the second one needed resuscitation and mechanical ventilation due to perinatal asphyxia. Even though rare in a previously unscarred uterus, uterine rupture can present in different forms and thus, requires vigilant evaluation of the patient and prompt intervention to avoid significant maternal or foetal morbidity and mortality. Early diagnosis and prompt intervention is of utmost importance for preventing significant maternal and foetal morbidity and mortality associated with it. Spontaneous uterine rupture defined as complete separation of the myometrium, is one of the rare occurrences and is associated with significant morbidity and mortality for both the mother and foetus 1. It is rarer in previously unscarred uterus with cases of uterine rupture reported in pregnant females with history of previous laparoscopic surgeries like adenomyomectomies, ectopic pregnancies and previous caesarean sections 2 — 4. We present a case of spontaneous uterine rupture at 36 weeks of gestation in a primi gravida female with twin pregnancy following in-vitro fertilization IVF for primary subfertility. A year-old primi gravida at 36 weeks 3 days of gestation with twin pregnancy after IVF for primary subfertility with history of cervical cerclage, which was removed at her regular antenatal visit at 36 weeks of gestation as elective caesarean was planned at 37 weeks presented to emergency with mild lower abdominal pain for 3—4 h. This pregnancy was after 11 years of marriage following an IVF with single embryo transfer for primary infertility. She had a past history of laparoscopic surgery for acute appendicitis under general anaesthesia. She had gestational diabetes and was under metformin. She denied any history of recurrent pregnancy losses and any other history of chronic medical illness like hypertension, chronic airway disease or connective tissue disorders. There was no any significant family or personal history. On examination, her vitals were stable and per abdominal examination revealed generalized tenderness. Foetal heart sounds were noted and were within normal limits. All her laboratory investigations including complete blood counts, renal function tests, coagulation profile and electrocardiogram were within normal limits. Her abdominal ultrasound done 3 days prior to the time of presentation revealed di-amniotic twins with uncertain chorionicity single anterior placenta or two fused placentas. Emergency caesarean section under subarachnoid block was planned due to precious twin pregnancy in labour. After arranging and cross-matching blood and taking informed written consent, the patient was shifted to operating room and monitors were attached. The baseline vitals were recorded and subarachnoid block was given with 2. After confirmation of the desired dermatomal level of anaesthesia, surgery was commenced. Painting and draping was done under all aseptic precaution and skin incision was given. Abdomen was opened in layers and after opening of the parietal peritoneum, ml of clots were removed. Babies were delivered with incision on the lower uterine segment, haemostasis was secured and the uterus was closed with continuous interlocking suture in two layers with vicryl 1. Pelvic gutter was cleaned and drain was placed after which abdomen was closed in layers. Skin was closed with prolene 2. Three episodes of hypotension were noted during the intraoperative period which was treated with intravenous fluid bolus and ephedrine. Slow intravenous methergin 0. One pint of whole blood was transfused intraoperatively based on the blood loss and intraoperative hemodynamics. Table1 1. The patient was shifted to intensive care unit for monitoring. Postoperative complete blood count revealed haemoglobin of 8. After 48 hs, the patient was shifted to ward with stable hemodynamics and laboratory parameters within normal limits. She was discharged on the 6th postoperative day and advised for follow-up in 1 week. Follow-up was done in outpatient department after 1 week and she was doing fine. Uterine rupture in a previously unscarred uterus is a rare occurrence involving 1 in 16 pregnancies 6. Most common causes for uterine rupture are known to be iatrogenic, drug-induced, cephalo-pelvic disproportion, placenta accreta and placental abruption 7 — Very few cases of uterine rupture in an unscarred uterus have been reported. Abbi et al. Similarly, Langton et al. There was another case reported by Walsh et al. In our case, the patient with twin pregnancy following IVF for primary subfertility presented with mild lower abdominal pain and generalized tenderness on palpation. We proceeded with this patient as a case of precious twin pregnancy after 11 years of marriage in labour and planned for emergency caesarean section under subarachnoid block as she was hemodynamically stable with normal complete blood counts which did not correlate with the intraoperative findings of hemoperitoneum and the uterine rupture. With a background of IVF, increased stretching of uterine wall due to twin pregnancy can be attributed to the rupture in our case. Uterine rupture can occur in a previously unscarred uterus even though rare. It can have different clinical presentations and requires prompt diagnosis and treatment to prevent maternal and foetal morbidity and mortality. Not applicable a case report does not require ethical approval at our institute. Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Medicine Baltimore , 10 :e, 01 Mar To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. Medicine Baltimore , 98 48 :e, 01 Nov Katwal P. J Obstet Gynaecol Res , 46 9 , 08 Jul Cited by: 3 articles PMID: Medicine Baltimore , 49 :e, 01 Dec Europe PMC requires Javascript to function effectively. Search life-sciences literature 44,, articles, preprints and more Search Advanced search. This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Mainali S 1 ,. Devkota S 2 ,. Elsaghi MAEE 1 ,. Soloman BO 1 ,. Bharati B 3 ,. Yadav P 3. Affiliations 1. Departments of Obstetrics and Gynecology. Authors Devkota S 2. Authors Bharati B 3 Yadav P 3. Share this article Share with email Share with twitter Share with linkedin Share with facebook. Abstract Spontaneous uterine rupture in an unscarred uterus is very rare. Case presentation Thirty three years female with twin pregnancy following in-vitro fertilization after 11 years of marriage presented to emergency department with lower abdominal pain at 36 weeks 3 days of gestation and was planned for emergency caesarean section for precious twin pregnancy in labour. Clinical findings and investigation She was vitally stable and on palpation of abdomen, there was generalized tenderness along with guarding. Conclusion Even though rare in a previously unscarred uterus, uterine rupture can present in different forms and thus, requires vigilant evaluation of the patient and prompt intervention to avoid significant maternal or foetal morbidity and mortality. Free full text. Ann Med Surg Lond. Published online Jun PMID: Author information Article notes Copyright and License information Disclaimer. Departments of a Obstetrics and Gynecology. Corresponding author. Sumnima Mainali: moc. E-mail: moc. Received Apr 12; Accepted Jun Published by Wolters Kluwer Health, Inc. The work cannot be changed in any way or used commercially without permission from the journal. This article has been cited by other articles in PMC. Go to:. Case presentation: Thirty three years female with twin pregnancy following in-vitro fertilization after 11 years of marriage presented to emergency department with lower abdominal pain at 36 weeks 3 days of gestation and was planned for emergency caesarean section for precious twin pregnancy in labour. Clinical findings and investigation: She was vitally stable and on palpation of abdomen, there was generalized tenderness along with guarding. Conclusion: Even though rare in a previously unscarred uterus, uterine rupture can present in different forms and thus, requires vigilant evaluation of the patient and prompt intervention to avoid significant maternal or foetal morbidity and mortality. Keywords: In-vitro fertilization, spontaneous uterine rupture, unscarred uterus. Open in a separate window. Figure 1. Figure 2. Table 1 Intraoperative findings and hemodynamics. Published online 20 June Spontaneous uterine rupture in the 33rd week of IVF pregnancy after laparoscopically assisted enucleation of uterine adenomatoid tumor. J Obstet Gynaecol Res ; 37 —7. Abbi M, Misra R. Rupture of uterus in primigravida prior to onset of labor. Int J Fertil Womens Med ; 42 — Spontaneous rupture of an unscarred gravid uterus at 32 weeks gestation. Hum Reprod ; 12 —7. Unexplained pre-labor uterine rupture in a term primigravida. Obstet Gynecol ; — Int J Surg ; 84 — Rupture of the unscarred uterus. Am J Obstet Gynecol ; Turner MJ. Uterine rupture. Spontaneous rupture of a primigravid uterus secondary to placenta percreta. J Reprod Med ; 43 —6. Rupture of pregnant uterus: a review. Obstet Gynecol Surv ; 33 — Rupture of unscarred uterus in primigravid woman in association with cocaine abuse. Am J Obstet Gynecol ; —7. Spontaneous rupture of liver in a patient with Ehlers Danlos disease type IV. Dig Dis Sci ; 42 — Smart citations by scite. The number of the statements may be higher than the number of citations provided by EuropePMC if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles. Explore citation contexts and check if this article has been supported or disputed. Silent uterine rupture in the term pregnancy: Three case reports. Similar Articles To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. Spontaneous rupture of unscarred uterus in the third trimester after in vitro fertilization-embryo transfer because of bilateral salpingectomy: A case report. Spontaneous unscarred uterine rupture in a primigravid patient at 11 weeks of gestation managed surgically: A rare case report. Spontaneous unscarred uterine rupture at 13 weeks of gestation after in vitro fertilization-embryo transfer: A case report and literature review. External link. Please review our privacy policy.

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