First-trimester uterine rupture: a case report and systematic review of the literature - 20/07/22
Abstract |
Objective |
This study aimed to present a case of first-trimester uterine rupture and perform a systematic review to identify common presentations, risk factors, and management strategies.
Data Sources |
Searches were performed in PubMed, Ovid, and Scopus using a combination of key words related to “uterine rupture,” “first trimester,” and “early pregnancy” from database inception to September 30, 2020.
Study Eligibility Criteria |
English language descriptions of uterine rupture at ≤14 weeks of gestation were included, and cases involving pregnancy termination and ectopic pregnancy were excluded.
Methods |
Outcomes for the systematic review included maternal demographics, description of uterine rupture, and specifics of uterine rupture diagnosis and management. Data were extracted to custom-made reporting forms. Median values were calculated for continuous variables, and percentages were calculated for categorical variables. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for case reports and case series.
Results |
Overall, 61 cases of first-trimester uterine rupture were identified, including our novel case. First-trimester uterine ruptures occurred at a median gestation of 11 weeks. Most patients (59/61 [97%]) had abdominal pain as a presenting symptom, and previous uterine surgery was prevalent (44/61 [62%]), usually low transverse cesarean delivery (32/61 [52%]). The diagnosis of uterine rupture was generally made after surgical exploration (37/61 [61%]), with rupture noted in the fundus in 26 of 61 cases (43%) and in the lower segment in 27 of 61 cases (44%). Primary repair of the defect was possible in 40 of 61 cases (66%), whereas hysterectomy was performed in 18 of 61 cases (30%). Continuing pregnancy was possible in 4 of 61 cases (7%).
Conclusion |
Uterine rupture is an uncommon occurrence but should be considered in patients with an acute abdomen in early pregnancy, especially in women with previous uterine surgery. Surgical exploration is typically needed to confirm the diagnosis and for management. Hysterectomy is not always necessary; primary uterine repair is sufficient in more than two-thirds of the cases to achieve hemostasis. Continuing pregnancy, although uncommon, is also possible.
Le texte complet de cet article est disponible en PDF.Key words : early pregnancy, first-trimester pregnancy, uterine rupture
Plan
| The authors report no conflict of interest. |
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| This study received no financial support. |
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| This study was registered with the International Prospective Register of Systematic Reviews (registration number CRD42020209171; originally registered on September 13, 2020). |
Vol 227 - N° 2
P. 209-217 - août 2022 Retour au numéro
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