Uterine rupture in a primigravid patient and anesthetic implications: a case report

Uterine rupture is an unexpected, relatively uncommon occurrence in the general obstetric population, but it is a potentially devastating complication. Uterine rupture of the unscarred uterus is extremely rare. Awareness of the risk factors as well as the signs and symptoms of uterine rupture are essential for an early diagnosis and prompt treatment. The patient is a 38-year-old female, gravida 3, para 0, at 38 weeks' gestation undergoing an elective labor induction. The induction of labor and epidural analgesia progress relatively uneventfully. Following approximately 1.5 hours of "pushing," a viable male infant was delivered. Newborn Apgar scores were 6 at 1 minute and 9 at 5 minutes. An hour after delivery the patient began complaining of syncope; at this time bleeding was greater than expected and the obstetrician decided a dilatation and curettage for retained placenta was necessary. A dilatation and curettage was negative, and an ultrasound of the abdomen revealed the presence of significant blood clots, laparotomy was performed, and uterine rupture was identified. The patient developed disseminated intravascular coagulation, uterine bleeding continued, and the patient ultimately required a hysterectomy.