Uterine rupture in an unscarred uterus after application of fundal pressure. A case report.
BACKGROUND
Rupture of an unscarred uterus is rare, with a reported incidence of 1 in 8,000-15,000 pregnancies. We report a case occurring during labor.


METHODS
A 33-year-old woman, gravida 3, para 0, abortion 2, was admitted at 40 weeks' gestation with ruptured membranes. Fundal pressure was applied during delivery due to maternal exhaustion. Uterine rupture was diagnosed from palpation of the fetal extremities coupled with a decreased fetal heartbeat. A 6-cm transverse laceration was discovered over the lower uterine segment during emergency cesarean section. The uterus was sutured. There were no further complications, and the postoperative course was uneventful.


CONCLUSIONS
Spontaneous rupture of the unscarred uterus during labor is rare, with only one case recorded at our institution over a 10-year period. Risk factors include weakness of the uterine muscle and the application of fundal pressure. Early detection and immediate surgical intervention are the mainstays of management.
Pan
Hun-Shan
HS
Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shin Lin District, Taipei, Taiwan.
Huang
Lee-Wen
LW
Hwang
Jiann-Loung
JL
Lee
Chun-Yi
CY
Tsai
Yieh-Loong
YL
Cheng
Wei-Chi
WC
D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009130:Muscle, Smooth / Q000473:pathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011312:Pressure; D012307:Risk Factors; D014597:Uterine Rupture / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000473:pathology