Ruptured Uterus in a Primipara with Previous Caesarean Section and Perinatal Mortality: One Case Too Many

Abstract

Primiparas with previous caesarean sections are risk factors for rupture of the gravid uterus especially among unbooked parturients attempting vaginal birth after previous caesarean sections. Maternal and perinatal mortality are high especially when these patients present late as unbooked emergencies. To present a case of ruptured uterus in a primipara with previous caesarean section and create awareness on management modalities. Mrs. E.S, 31year old unbooked G2 para 1⁺⁰  at 41 weeks of gestation who presented on self-referral from the home of a traditional birth attendant (TBA) with 2days history of passage of show and drainage of liquor and 1 day history labour pains, abdominal massage and inability to feel fetal kicks. The findings on examination revealed clinical features of ruptured uterus and intrauterine fetal death. Urgent obstetric sonogram confirmed instrauterine fetal death. She had an emergency laparotomy, extraction of a fresh stillborn male baby, repair of the ruptured uterus and bilateral tubal ligation. She had 2 units of blood transfused intra-operatively and 1 unit post-operatively. Her post-operative period was uneventful. She was discharged home on her 11th post-operative day in stable clinical condition. Ruputured uterus is a dire obstetric emergency. Prompt diagnosis and treatment helps prevent adverse effects in the mother and baby. Pregnant women should be encouraged to register for antenatal care and delivery supervised by skilled birth attendant.