Rupture of unscarred uterus in primigravid woman in association with cocaine abuse

Article Abstract:

With the rising incidence of cocaine abuse in the United States, the prevalence of cocaine use among pregnant women has also increased. Studies show that cocaine use is associated with: preterm (early) labor; abruptio placentae, which is the early detachment of the placenta from the uterus after the twentieth week of gestation; and placenta previa, the abnormal implantation of the placenta in the lower portion of the uterus. A case is described of a 19-year-old woman who developed pain in the abdomen at 32 weeks gestation. She had not received prenatal care and had a history of cocaine abuse. Ultrasonography, a diagnostic method in which sound waves are used to visualize the fetus, showed evidence of placenta previa, possible abruptio placentae, and slowed growth of the fetus. The patient underwent surgery to explore the abdomen. Her uterus had ruptured and the fetus was located in the right upper abdominal cavity. Although the infant was delivered successfully, the mother's uterus was removed surgically because of irreparable damage. Rupture of the uterus can result from many conditions, such as abnormalities or previous surgery on the uterus, but its association with cocaine abuse has never been reported. The development of abruptio placentae and placenta percreta, the abnormal growth of the placenta deep into the uterus, may have contributed to the rupture of the uterus. Pain in the abdomen, tenderness of the uterus, inability to detect the fetal heart beat, bleeding, and shock are symptoms of uterine rupture. Patients with these symptoms should be assessed for drug abuse, and should undergo surgery to examine the abdomen. The weakening of the uterine wall by placenta percreta and uterine contractions associated with cocaine use may have led to rupture of the uterus in this case. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cocaine abuse, Drug abuse in pregnancy

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Elective versus emergency cesarean hysterectomy cases in a residency program setting: a review of 129 cases from 1984 to 1988

Article Abstract:

Emergency hysterectomy is often used to treat women with severe bleeding that occurs following a cesarean section. Elective hysterectomy may be performed when there are indications that complications are likely to occur following cesarean section. This study examined the outcomes of both types of surgeries as performed in a residency program setting. The charts from cesarean hysterectomies performed between 1984 and 1988 were reviewed and classed as either elective or emergency. Results showed that during the study period there were 33,963 deliveries, of which 4,891 (14.2 percent) were cesarean sections. There were 129 cesarean hysterectomies performed, of which 107 were elective and 22 were emergency cases. Emergency surgery was required mainly due to hemorrhage or uterine rupture. Elective surgery was opted for mainly because of previous cesarean deliveries and no desire to have further children or indications that future gynecologic problems were likely. Operating time and blood loss were greater for emergency surgeries than for elective surgeries. Incidence of blood transfusions was 68 percent for the emergency patients and 14.6 percent for the elective patients. No deaths occurred from surgery. Complications from surgery included fever in 40 percent of the emergency cases and 18.3 percent of the elective cases. These results indicate that elective cesarean hysterectomy is a safe and effective procedure for selected patients. It is also an appropriate surgery for residents to be trained on so that they are prepared when emergency cases arise. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Surgery, Cesarean section, Hysterectomy, Surgical emergencies

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Spontaneous rupture of the unscarred uterus

Article Abstract:

Induction of labor with the drug oxytocin may contribute to rupture of the unscarred uterus during labor in certain unusual cases. Researchers reviewed the medical literature and two cases of uterine rupture during labor. The two pregnant women had given birth three times before without cesarean sections, and they both experienced rupture of the uterus after receiving oxytocin. Both mothers and infants survived. Neither woman had recognizable risk factors before these deliveries. After delivery, however, it was evident that they shared the risk factor of giving birth to larger than normal infants. Oxytocin should be administered with care to women who have given birth several times before and who are suspected of having large fetuses.

Risk factors, Pregnancy, Complications of, Pregnancy complications, Oxytocin

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