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Obstetrical hemorrhages, a reality that endangers the patient s life

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The chosen case is not one of the few uterine ruptures cases, however it is rare through the cause of appearance, uterine scar post laparoscopic myomectomy (0.75%) and the moment of appearance in the second pregnancy trimester (1). This is the case of a 43 years old woman, 21 weeks pregnant obtained through IVF, brought to the Emergency Room manifesting faintness, abdominal pain, nausea and vomiting.
The diagnosis was: acute abdomen, haemoperitoneum, hemorrhagic shock, suspicious of uterine rupture, 21 weeks old pregnancy obtained through FIV, antepartum stillbirth, uterine scar postlaparoscopic myomectomy 2013. Presumptive diagnosis was supported by patient history, clinical examination, ultra-sound and laboratory explorations.
The patient was immediately admitted to hospital, the first steps of volume replacement have been made, emergency exploratory laparotomy has been performed, intraoperative intervention certifies the diagnosis of complete uterine rupture, stillbirth antepartum, haemoperitoneum; dual-layer uterine suture is tried but without success; continued with subtotal inter-adnexal hysterectomy for hemostasis.
Postoperative patient evolution was favorable. The uterus rupture is an obstetric emergency, threatening the patient’s live through high bleeding possibility, which can occur on normal, scarred or malformed uterus. Moreover, a scarred uterus post caesarean surgery, segment-transversal, middle-corporeal, on scarred uterus post myomectomy with various anatomical location, malformed uterus represent a great responsibility and challenge for the obstetrician MD who cares for such a patient.

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