Uterine rupture in early pregnancy

Abstract

Introduction: The incidence of sterile couples, according to various authors, varies between 10- 20%. In each region, depending on the socio-economic and cultural level of the population, the frequency of sterility in Moldova is 14-15%, Russia-10-15 %, in Romania -10-20% in France-20% and in the U.S., 30%. Experiments on IVF method implementation, in Moldova, started in 1994. First pregnancy was obtained by IVF method, at the end of 1995 and ended with the birth of a boy weighting 3500 grams. Wider use of IVF method began in 1997, together with the implementation of transvaginal ultrasound in monitoring of stimulation cycles and echographic sampling of the oocytes. Since then, many couples who have lost all hopes of having a child were able to enjoy the opportunity to be parents. Normal course of pregnancy occurred through IVF, otherwise as in the case of pregnancy occurring physiologically, depends on a whole team of physicians, who’s main task is to prevent the occurrence of complications that can affect both the mother's life as well as the life of the child. Purpose and Objectives: Presentation of a clinical case of pregnancy, with duplex occurred after IVF, which in the period of 12 weeks had a less favorable evolution, endangering the patient’s life and depriving her of the opportunity to further being able to have children. Materials and methods: A 29 years old patient, third pregnancy, nulliparous, 12 weeks pregnancy after IVF, COA (bilateral salpingectomy) - in a progressively worsening condition, altered neuro-psycho logical status, Bp 50/0 mmHg, Ps 112, respiration 23/min, on palpation of the abdomenabdominal muscles’ endurance, ultrasonography determines - uterine pregnancy, monofetal, in terms of 12 weeks with positive fetal heartbeat, in the abdominal cavity - fluid up to diaphragm. Results: Were performed lower median laparotomy and in the abdominal cavity were found: a product of conception with the placenta, endometrial fragments, 2500 ml blood, the source of the hemorrhage being rupture of the uterus. A decision was made to perform subtotal hysterectomy with preservation of the cervix and ovary. Postoperatively, on sectioning the uterus were found: another product of conception and an intramural myomatous node of 6 cm. Conclusion: Due to the complexity and difficulty in the diagnosis of acute abdomen, on the uterine pregnancy background, the case was served by sanitary aviation team. The patient's life was saved, but reproductive organ preservation was not possible.