Spontaneous Complete Uterine Rupture in a Nonlaboring, Early Third-trimester Uterus: Missed Diagnosis by Ultrasound

Abstract

Objective Describe potential consequences and remedy for not intermittently auscultating fetal heart tones during travel to the imaging department and misdiagnosing a ruptured uterus on ultrasound as a synechiae.

Study Design Retrospective chart review of case.

Results Spontaneous uterine rupture in pregnancy is a rare and catastrophic event. Fetal monitoring is an important component for diagnosis, but fetal heart auscultation is usually discontinued while the patient is receiving imaging. We present a ruptured uterus at 28 weeks with delayed diagnosis secondary to interrupted fetal heart tone auscultation and a misdiagnosis of a rupture as a synechiae resulting in a seriously compromised newborn at delivery.

Conclusion Intermittent fetal heart tone auscultation is a possible method of monitoring when the patient is off continuous fetal monitoring.

Keywords

uterine rupture - third trimester - spontaneous - fetal auscultation

• References

• 1 Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome—one century later. Fertil Steril 2008; 89: 759-779
• 2 Dow M, Wax JR, Pinette MG, Blackstone J, Cartin A. Third-trimester uterine rupture without previous cesarean: a case series and review of the literature. Am J Perinatol 2009; 26: 739-744
• 3 Langton J, Fishwick K, Kumar B, Nwosu EC. Spontaneous rupture of an unscarred gravid uterus at 32 weeks gestation. Hum Reprod 1997; 12: 2066-2067
• 4 Chigbu B, Onwere S, Kamanu C, Aluka C, Adibe E, Onichakwe C. Rupture of the uterus in a primigravida: a case report. Niger J Clin Pract 2010; 13: 233-234
• 5 Singh A, Jain S. Spontaneous rupture of unscarred uterus in early pregnancy—a rare entity. Acta Obstet Gynecol Scand 2000; 79: 431-432
• 6 Jain L, Ferre C, Vidyasagar D, Nath S, Sheftel D. Cardiopulmonary resuscitation of apparently stillborn infants: survival and long-term outcome. J Pediatr 1991; 118: 778-782
• 7 Ross MG, Gala R. Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. Am J Obstet Gynecol 2002; 187: 1-9
• 8 Low JA, Lindsay BG, Derrick EJ. Threshold of metabolic acidosis associated with newborn complications. Am J Obstet Gynecol 1997; 177: 1391-1394
• 9 Walsh CA, Baxi LV. Rupture of the primigravid uterus: a review of the literature. Obstet Gynecol Surv 2007; 62: 327-334 , quiz 353–354