title: Spontaneous Posterior Uterine Rupture in Twin-Twin Transfusion Syndrome.
abstract: Background The maternal and fetal risks of uterine distension in rapidly progressive twin-twin transfusion syndrome (TTTS) in the setting of prior uterine scar are poorly characterized. Case We present the case of a 42-year-old woman, G4P1201, at 21 weeks gestation with stage-1 TTTS who developed a spontaneous posterior uterine rupture necessitating emergent laparotomy and delivery of previable fetuses, possibly due to prior uterine scar from a displaced intrauterine device. Conclusion TTTS may be a risk factor for uterine rupture, including uterine rupture in atypical anatomic locations. Prior unrecognized uterine scars, including perforations, may magnify the risk for atypical uterine rupture in the setting of excessive uterine distension.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Marcela C
authors.initials: MC
authors.lastname: Smid
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh, Magee Women's Hospital, Pittsburgh, Pennsylvania.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Waltner-Toews
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: William
authors.initials: W
authors.lastname: Goodnight
keywords: twin pregnancy; twin-twin transfusion syndrome; uterine rupture