title: Expectant management of a herniated amniotic sac presenting as silent uterine rupture: a case report and literature review.
abstract: Foetal membranes bulging into the abdominal cavity is a unique initial manifestation of silent or complete uterine rupture during pregnancy. Since silent uterine rupture has potential risk for complete uterine rupture, which leads to acute life-threatening complications for both the mother and baby, it is difficult to determine whether to manage expectantly or surgically, including repair of the uterine wall or termination of the pregnancy, especially in the early second trimester. We present here a case of a herniated amniotic sac with overstretched uterine wall of the fundus presenting as silent uterine rupture, which was incidentally detected on routine ultrasonography at 18 weeks' gestation in a 38-year-old primigravida with a history of myomectomy for diffuse uterine leiomyomatosis. Magnetic resonance imaging examination revealed that the myometrium thickness was fully maintained at the site of the foetal membranes ballooning. The pregnancy was therefore managed expectantly and continued to successful delivery at 30 weeks' gestation. The precise assessment of the uterine wall may be essential to manage a herniated amniotic sac presenting as silent uterine rupture and to optimise the outcome of the pregnancy. We review all cases of a herniated amniotic sac out of focally overstretched uterine wall before 34 weeks' gestation.
authors.affiliation: Department of Gynaecology and Obstetrics, Kyoto University , Kyoto , Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Iemura
authors.forename: Eiji
authors.initials: E
authors.lastname: Kondoh
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Kohei
authors.initials: K
authors.lastname: Fujita
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ueda
authors.forename: Haruta
authors.initials: H
authors.lastname: Mogami
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Baba
authors.forename: Ikuo
authors.initials: I
authors.lastname: Konishi
mesh_terms: D000328:Adult; D000650:Amnion / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging*; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014597:Uterine Rupture / Q000175:diagnosis*
keywords: Conservative management; diffuse uterine leiomyomatosis; pregnancy; uterine dehiscence; uterine rupture