Dissection of the uterine wall in a scarred uterus: a case report

Abstract

Uterine rupture is a potentially fatal complication during pregnancy, delivery, or postpartum. Women attempting a trial of labor after a cesarean section have an increased risk of a subsequent rupture. We report a case of a 24-year-old woman, gravida 2 para 1 with a previous cesarean section who underwent a trial of labor. During labor she complained of pain while labor progressed rapidly. Because of signs of fetal distress, a vacuum extraction was performed. Two hours after delivery, the patient complained again of severe abdominal pain. Blood accumulated in a previously non-existent area between the serosa and uterine muscle. A dissection of the uterine wall occurred with serious clinical consequences, compatible with a complete uterine rupture. Emergency laparotomy was performed to repair the uterine wall; a hysterectomy was prevented.