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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(03): e300-e303
DOI: 10.1055/s-0040-1715175
Case Report

Late Presentation of Uterine Rupture Following Vaginal Birth After Cesarean Delivery: A Case Report

Lindsey A. Choi 
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Tripler Army Medical Center, Honolulu, Hawaii
,
Ariel A. Chung 
2   Department of Family Medicine, Tripler Army Medical Center, Honolulu, Hawaii
,
Brian Pierce 
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Tripler Army Medical Center, Honolulu, Hawaii
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Abstract

Background A trial of labor after cesarean delivery is associated with uterine rupture rates of 0.5 to 0.9%, which can have devastating neonatal and maternal consequences. While uterine rupture typically occurs during labor, it can clinically manifest after delivery.

Case A 23-year-old multiparous female presented in labor at term. Her obstetrical history was significant for a prior low transverse cesarean delivery. She had an uncomplicated labor course and spontaneous vaginal delivery.

Immediately after delivery, she complained of severe right shoulder and left lower quadrant pain. Bedside ultrasound revealed a 10-cm, complex, adnexal mass adjacent to the uterus without free fluid. She was hemodynamically stable and appeared clinically well. On repeat ultrasound, the mass was unchanged; however, the patient now had free intraperitoneal fluid along the liver edge.

Emergent laparotomy revealed a uterine rupture along her prior hysterotomy with extension into the right uterine artery. A 10-cm broad ligament hematoma ruptured posteriorly resulting in a 1-L hemoperitoneum. She received multiple blood products intraoperatively and recovered well postpartum.

Conclusion Delivery after trial of labor after cesarean delivery usually decreases acuity; however, these patients remain at risk for significant complications. Clinicians should continue to assess patients in the immediate postpartum period and proceed with surgical intervention if necessary.

Keywords

uterine rupture - trial of labor after cesarean - vaginal birth after cesarean - obstetrical emergency - uterine dehiscence

Note

The views expressed in this abstract/manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.




Publication History

Received: 13 April 2020

Accepted: 16 May 2020

Article published online:
23 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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