Adenomyosis and spontaneous uterine rupture in the second trimester of pregnancy: case report
Adenomiosis y ruptura uterina espontánea en el segundo trimestre de embarazo: reporte de caso
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Introduction:
Adenomyosis is a common gynecological condition; however, cases of uterine rupture leading to fatal complications are rare, particularly in primiparous patients with no history of uterine surgery.
Case report:
We report the case of a 27-year-old patient, Gravida 1, Para 0 patient who was in her second trimester of pregnancy and had a history of adenomyosis (ultrasound diagnosis) and endometriosis (laparoscopy history). She was admitted to the emergency room due to abdominal pain, with no other associated symptoms, with normal fetal monitoring. Shortly after admission, she experienced hemodynamic deterioration and developed signs of peritoneal irritation, which necessitated an urgent laparotomy. During the procedure, we discovered a fetus in the abdominal cavity and hemoperitoneum. Fetus with respiratory effort and pulse in the umbilical cord weighing 789 grams, required cardiopulmonary resuscitation, with subsequent death.
Conclusion:
This type of patient should be counseled about the rare but possible risk of uterine rupture, subsequent maternal and perinatal complications such as spontaneous abortion, preeclampsia, small fetus for gestational age, premature birth and cesarean section. In addition, they should be informed about clear warning signs to go to the nearest health center with obstetrics service. The most frequent signs associated with uterine rupture include: sudden onset of intense abdominal pain associated with hypovolemic shock, uterine hypersensitivity and decelerations of the fetal heart rate.
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