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Fatal consequences of uterine rupture in late pregnancy


Authors: Šidlová Henrieta 1,2;  Očko Peter 3,4;  Mikuláš Ubomír 3,4;  Šikuta Ján 3,4;  Šidlo Jozef 3,4
Authors place of work: Ústav patologickej anatómie, Lekárska fakulta, Slovenská zdravotnícka univerzita v Bratislave, Bratislava, Slovenská republika 1;  Ústav patologickej anatómie, Onkologický ústav sv. Alžbety, Bratislava, Slovenská republika 2;  Ústav súdneho lekárstva, Lekárska fakulta, Univerzita Komenského v Bratislave, Bratislava, Slovenská republika 3;  Súdnolekárske pracovisko, Úrad pre dohľad nad zdravotnou starostlivosťou, Bratislava, Slovenská republika 4
Published in the journal: Soud Lék., 65, 2020, No. 3, p. 65-66
Category: Původní práce

Summary

Uterine rupture in pregnancy belongs to acute conditions in gynaecology and obstetrics. It is a life-threatening complication for both mother and foetus. The occurrence of fatal consequences in developed countries is very rare. The causes of rupture include scarring after the caesarean section, fibroid enucleation, rough curettage, muscular insufficiency in uterine developmental defects, uterine wall damage due to inflammation, uterine hypoplasia, elevated intrauterine pressure during contraction, cephalopelvic disproportion, previous fibroid, prostaglandin or oxytocin administration, etc. This paper aims at the presentation of a 32-year-old woman who died in the 35th week of gestation due to uterine rupture at home despite having been transferred to a medical facility at the terminal stage of life. At the autopsy, a complete rupture of the posterior uterine wall with bleeding into the abdominal cavity and an amniotic sac with a male foetus in the abdominal cavity was found. There were no signs of the effects of violence detected. Histopathological examination revealed no pathological changes in the uterine muscle. The immediate cause of maternal death was a haemorrhagic shock. The autopsy of the foetus revealed signs of asphyxia. The immediate cause of foetal death was intrauterine asphyxia. In this case, forensic expertise ruled out the violent causes of uterine rupture and deaths in terms of mechanical and chemical factors and supported to make a diagnosis of spontaneous rupture.

Keywords:

pregnancy – Autopsy – uterine rupture – examined circumstances


Zdroje

1. Suner S, Jagminas L, Peipert JF, Linakis J. Fatal spontaneous rupture of a gravid uterus: Case report and literature review of uterine rupture. J Emerg Med 1996; 14(2): 181-185.

2. Kwee A, Bots ML, Visser GHA, Bruinse HW. Uterine rupture and its complications in the Netherlands: A prospective study. Eur J Obstet Gynecol Reprod Biol 2006; 128: 257-261.

3. Guéye M, Mbaye M, Ndiaye-Guéye MD, et al. Spontaneous uterine rupture of an unscarred uterus before labour. Case Rep Obstet Gynecol 2012; 2012: 1-3.

4. Verma M, Bairwa R. Unscarred uterine rupture: a retrospective analysis in tertiary center. Int J Reprod Contracept Obstet Gynecol 2018; 7(4): 1318-1321.

5. Zhao Y, Tian B, Xu Y, Dai H. Spontaneous prelabor unscarred uterine rupture in primigravida: a case report and review of literature. Int J Clin Exp Med 2017; 10(4): 7296-7303.

6. Hofmeyr GJ, Say L, Gülmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG 2005; 112(9): 1221-1228.

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