Rupture of nulliparous uterus is very rare. It is associated with mullerian anomalies. A 20yr old woman was brought to casualty, from a rural area 100km away, at 1230pm with complaints of severe pain in the epigastrium since morning. no history of gastritis, vomitings or diarrhea or vaginal bleeding. She was a primigravida with 14weeks gestation.
On arrival no peripheral pulses were felt and blood pressure was unrecordable. 2 large bore IV cannulae were inserted and plasma expanders and crystalloids were started. Bloods were taken for grouping, cross-matching, serum amylase. Examination revealed a tense abdomen and uterus of size 14weeks, nontender. She was intubated and ventilated as oxygen saturations were not recordable. Bedside ultrasound scan revealed a intrauterine pregnancy of same gestation and abdomen and pelvis with massive amounts of free fluid. aspirate under ultrasound guidance confirmed blood in abdomen and she was taken for laparotomy at 1300hrs. intraoperatively, 2.5ltrs of clots were removed and the fetus was by then floating in the blood. oninspection, the right tube and ovary were normal, but the placents was seen projecting from a rent in the right horn of the bicornuate uterus. with the unmbilical cord attached to the fetus. the right horn along with the placenta was excised at the attachment to the left horn and sutured. She made good recovery.
She was advised not to get pregnant for a year to allow healing and was also warned of similar occurrence in her next pregnancy in the left horn and to seek medical attention very early on in pregnancy.
On arrival no peripheral pulses were felt and blood pressure was unrecordable. 2 large bore IV cannulae were inserted and plasma expanders and crystalloids were started. Bloods were taken for grouping, cross-matching, serum amylase. Examination revealed a tense abdomen and uterus of size 14weeks, nontender. She was intubated and ventilated as oxygen saturations were not recordable. Bedside ultrasound scan revealed a intrauterine pregnancy of same gestation and abdomen and pelvis with massive amounts of free fluid. aspirate under ultrasound guidance confirmed blood in abdomen and she was taken for laparotomy at 1300hrs. intraoperatively, 2.5ltrs of clots were removed and the fetus was by then floating in the blood. oninspection, the right tube and ovary were normal, but the placents was seen projecting from a rent in the right horn of the bicornuate uterus. with the unmbilical cord attached to the fetus. the right horn along with the placenta was excised at the attachment to the left horn and sutured. She made good recovery.
She was advised not to get pregnant for a year to allow healing and was also warned of similar occurrence in her next pregnancy in the left horn and to seek medical attention very early on in pregnancy.
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