Intrapartum uterine rupture and inflammatory bowel disease

Article Abstract:

Uterine rupture occurs in up to one percent of pregnant women. A case is reported of uterine rupture in a 24-year-old woman who had a 10-year history of Crohn's disease, inflammatory bowel disease. She had delivered three children previously and was dependent on corticosteroids for control of intestinal inflammation. However, corticosteroids also decrease wound healing, and this may have led to poor scar formation in the uterus. The patient developed nausea, vomiting, diarrhea, and contractions at 33 weeks' gestation; normal delivery is at 40 weeks. She had been hospitalized during the pregnancy for other occurrences of preterm labor and exacerbation of intestinal disease. The previous delivery was premature, at 27 weeks, due to premature detachment of the placenta, and was accomplished by cesarean section. Both previous cesarean sections and placental detachment predispose women to subsequent uterine rupture. During hospitalization, the contractions gradually responded to medication, and fetal reactions were good. However, on the seventh day in the hospital, severe abdominal pain suddenly developed, vaginal spotting occurred, and fetal heart beat decreased. An immediate cesarean section delivered a 3.9 pound boy with low Apgar scores (an index of cardiovascular and other function). The uterus had ruptured and was removed. Both mother and child were discharged in good health 11 days later. In cases of uterine rupture, a good outcome is associated with an intact amniotic sac, as was the case in this study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Inflammatory bowel diseases, Prednisone

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Uterine rupture at term pregnancy with the use of intracervical prostaglandin E2 gel for induction of labor

Article Abstract:

Prostaglandin E2 (PGE2) is a product of arachidonic acid metabolism and has been used to prepare the cervix (opening of the uterus) for delivery and to induce labor. PGE2 rarely cause serious side effects in the mother or newborn. However, a case is described of a 28-year-old woman who developed rupture of the uterus after PGE2 gel was applied to the cervix to induce labor. The patient was in the forty-second week of her third pregnancy. Deliveries of the two previous pregnancies were uncomplicated and the patient's medical history was unremarkable. The uterus started contracting an hour after PGE2 administration, and three hours later, the infant developed bradycardia (a slowed heart rate) and was delivered immediately. The mother developed symptoms of shock and pelvic examination revealed a ruptured uterus. The uterus was surgically removed and the child and mother recovered without complications. In this case, PGE2 caused excessive stimulation and contraction of the uterus, resulting in fetal bradycardia. Patients treated with PGE2 should be continuously and carefully monitored for signs of overstimulation or rupture of the uterus. Beta-2 sympathomimetic drugs can be given to reverse hyperstimulation of the uterus by PGE2. Perhaps, overstimulation of the uterus by PGE2 may be prevented if PGE2 is given by a route other than direct application to the cervix. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Prostaglandins E, Labor, Complicated, Labor complications

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Concomitant use of glucocorticoids: a comparison of two metaanalyses on antibiotic treatment in preterm premature rupture of membranes

Article Abstract:

Corticosteroids used during premature labor may reduce the effectiveness of antibiotics used to prevent premature birth. Premature birth has been linked to infection and antibiotics can reduce the risk of premature birth. Corticosteroids are also given to women in premature labor to reduce the rate of fetal distress. Researchers reviewed studies that analyzed the outcome in pregnant women given both drugs or just antibiotics. In women given antibiotics alone, the rates of serious complications of premature birth were substantially reduced. However, this was not the case in women who were given both drugs.

Health aspects, Antibiotics, Prevention, Premature birth

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