Antepartum uterine rupture at the fundus following B-Lynch sutures in the previous delivery

Background B-Lynch sutures for treatment of postpartum hemorrhage still seem to be unidentified as a possible risk factor for uterine rupture. Our rare case highlights the fact that knowing risk factors for uterine rupture is essential for patient’s management.

Clinical history/findings A 38-year-old GII/PI at 34+4 weeks of gestation was admitted with acute abdominal pain and circulatory disorders. No trauma or uterine contractions were reported. The patient had a history of a caesarean section 34 months earlier with application of B-Lynch sutures. The cardiotocography detected a normal fetal heart rate. An abdominal ultrasound showed a transverse fetal position, free fluid and an abrupt discontinuation of the myometrium in the lower uterine segment. The decision to perform an urgent caesarean section has been taken.

Diagnosis Intraoperatively, a hemoperitoneum and a dehiscence of the scar in the lower uterine segment was found. Moreover, the uterine fundus showed the pictured rupture in between the grooves of the previous B-Lynch sutures, extending through all uterine wall layers.

Management/outcome: The delivery of the newborn was performed by a low transverse uterine incision without complications (APGAR 7/8/8). The defect was repaired in two layers. Both were discharged in good condition.

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Artikel online veröffentlicht:
11. Oktober 2022