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Omentum Through the Vulva as First Sign of a Uterine Rupture

Guasch, E PhD; Millan, M J. PhD; Gilsanz, F PhD; González, A PhD

doi: 10.1213/01.ANE.0000139732.36153.D1
Letters to the Editor: Letters & Announcements
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Department of Anesthesiology (Guasch, Millan, Gilsanz)

Department of Obstetrics; Hospital Universitario “La Paz”; Madrid, Spain; emiguasch@hotmail.com (González)

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To the Editor:

We report a case of rare uterine rupture. Our 38-year-old patient had suffered three curettages in the past. Spontaneous vaginal delivery took place under epidural anesthesia, and after placental outcome, the omentum prolapsed through the vulva. The patient became nauseated with a heart rate of 110 bpm but was not hypotensive. Blood specimen for type screen was obtained, and a laparotomy was immediately performed after a rapid sequence induction of general anesthesia. The uterine rupture was repaired and blood transfusion was unnecessary. The trachea was extubated after surgery, and the patient was transferred to the PACU and discharged from hospital 4 days later.

Uterine rupture is uncommon (1,2). Marsden (3) described a patient whose omentum prolapsed after a vaginal delivery. A risk factor could be a previous curettage.

The anesthetic choice depends on maternal hemodynamics, risk of hysterectomy, and expected or real blood loss (1,4). We preferred general anesthesia, because we expected a massive blood loss. Classical signs of a uterine rupture were not observed (5). Other signs observed were vernixuria (6) and an extrusion of fetuses into the urinary bladder (7). With an in-house staff and utilizing close maternofetal monitoring, uterine rupture does not result in higher mortality (8).

This situation may be seen more often in future, because of the increasing number of cesarean sections.

E. Guasch, PhD

M. J. Millan, PhD

F. Gilsanz, PhD

Department of Anesthesiology

A. González, PhD

Department of Obstetrics

Hospital Universitario “La Paz”

Madrid, Spain

emiguasch@hotmail.com

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References

1. Bucklin BA. Vaginal birth after cesarean delivery. Anesthesiology 2003;99:1444–8.
2. Shipp TD. Trial of labor after cesarean: so what are the risks?. Clin Obstet Gynecol 2004;47:365–77.
3. Marsden DE. Omentum presenting at the vulva after a normal labor and delivery: an unusual late complication of induced abortion. Acta Obstet Gynecol Scand 1984;63:277–8.
4. Stalnacker BL, Maher JE, Kleinman GE, et al. Characteristics of successful claims for payment by the Florida Neurologic Injury Compensation Association Fund. Am J Obstet Gynecol 1997;177:268–71.
5. Eden RD, Parker RT, Gall SA. Rupture of the pregnant uterus: a 53 year review. Obstet Gynecol 1986;68:671–4.
6. O’Grady JP, Prefontaine M, Hoffman DE. Vernixuria: another sign of uterine rupture. J Perinatol 2003;23:351–2.
7. Fasubaa OB, Adetiloye VA, Baraletei AC, et al. Rupture of uterine scar with extrusion of twin fetuses into the urinary bladder: a case report. West Afr J Med 2001;20:158–60.
8. Yap OW, Kim ES, Laros RK Jr. Maternal and neonatal outcomes after uterine rupture in labor. Am J Obstet Gynecol 2001;184:1576–81.
© 2004 International Anesthesia Research Society