Diagnosis of Uterine Rupture on CT  

Oleh:

Eller, Alexandra Grosvenor ; Fisher, Barbra

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 360 no. 02 (Jan. 2009), page 170.

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2009.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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A 34-year-old woman with seven previous cesarean deliveries and a history of scant prenatal care presented at 32 weeks' gestation with constant, vague lower abdominal pain that had worsened over the past day. Her vital signs were normal, and the examination was notable for tenderness in both lower quadrants. Laboratory tests revealed a hematocrit value of 39% and a white-cell count of 18,300 per cubic millimeter with 8% bands. The fetal status was reassuring, on the basis of a reactive heart-rate tracing with rare variable decelerations. Infrequent uterine contractions were noted, and the cervix was long and closed with no evidence of ruptured membranes on speculum examination. Abdominal ultrasonography was notable for oligohydramnios, which severely limited the quality of the study and precluded diagnostic amniocentesis, but the fetal measurements were appropriate for the gestational age. Abdominal computed tomography (CT) was performed, owing to worsening maternal pain and concern about appendicitis. The CT scan revealed a fetal hand protruding through the lower uterine segment (Panel A, arrow). The patient initially declined surgery, but a cesarean section performed 12 hours later showed complete disruption of the hysterotomy scar from a previous delivery, with a fetal hand in the maternal abdomen (Panel B). The site of uterine rupture in the lower uterine segment was extended laterally to permit delivery of the fetus, and then the hysterotomy was repaired in the usual fashion. A vigorous male infant with a 5-minute Apgar score of 9 was delivered. The mother's postpartum course was uneventful, and she was discharged home on postoperative day 4. The infant remained in the neonatal intensive care unit, owing to prematurity, and was discharged in good condition on day 20 of life. Subacute, noncatastrophic, complete dehiscence of the uterine scar is rare.

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