[A uterine rupture during peridural anesthesia]

A 31 years old multiparous woman was delivered by caesarean section at her first pregnancy. For her third, spontaneous, full-term labour an epidural analgesia was realized with 0.125% epinephrined bupivacaine and fentanyl (1 mg per kg). In spite of its initial efficacy, pains appeared only localized at the caesarean scar. An uterine rupture was suspected, due probably to the use of oxytocin. The operating room was immediately prepared for an emergency caesarean section. As none other pejorative clinical manifestation was present, vaginal delivery was pursued and an healthy boy was taken out after application of forceps. The uterine revision and the secondary laparotomy, performed under epidural anesthesia, confirmed an uterine break, not very wide. The end result was satisfactory both for the mother and the child. The use of epidural analgesia and oxytocin are discussed from the literature and the clinical facts. The absence of internal tocography is an arguable point in this case report.