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KMID : 0358419670100020019
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Korean Journal of Obstetrics and Gynecology
1967 Volume.10 No. 2 p.19 ~ p.23
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Spontaneous Rupture of the Intact Uterus During Labor
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安貞體/Ahn, Chung Rye
李順培/田春惠/趙冕鎬/Rhee, Soon Bai/Chun, Hye Choon/Cho, Myun Ho
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Abstract
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In the 6 year period from Jan. 1961 to Dec. 1966, a single case of spontaneous rupture of intact pregnant uterus during labor was experienced in a total of 11,111 deliveries at Ewha Womans University Hospital, Seoul.
The patient, gravida.7, para 3, 31 year of age, term pregnant woman was admitted into the labor room in Nov. 30, 1966 with ceasing pain following some 41/2 hours active labor pain at home.
The past history revealed that only she has had two times early spontaneous abortions and a tubal pregnancy of one year previousely.
On the admission the cervix was fully dilated but without progressing and the presenting part of the vertex was completely engaged.The B.P. was 90/0, pulse 132/min. The oxygen mask was applied to the patient although there was no any restlessness or pale appearance. 21/2 hour after the admission, X-ray peivimetry was taken and showed a suggestive of borderline transveverse arrest although she has had 3 times normal vaginal deliveries previousely.
She developed two times vomitings, then the B.P. suddenly dropped to 70/0 or 50/0, became pale, and evidently is in the shock. The abdomen, however, was so soft and the two different prominent parts could be palpated, suggestive of the fetal head and uterine fundus.
During the immediate laparatomy the B.P. was controlled by giving 5,000 c.c. of blood transfusion and total hysterectomy was performed in good condition for the longitudinal spontaeous rupture of left low portion of the uterus extending to the upper vaginal wall.
In the spontaneous rupture of the uterus during labor or advanced stage especially in the lateral longitudinal rupture, the bleeding from the proximal end of the severed uterine artery seems tend to stop temporally probably due to the accumulated blood clots in the limited retroperitoneal space occuring the inital stage of the rupture. The bleeding from the lateral vesical plexus, however, was so profuse, never seemed to be stopped anatomically by the natural clotting mechanism.
We would like to emphasize that searching and ligation of the silent proximal end of the uterine artery, masking in the numerous clots should never be missed since it will subsequently pop up by the time of the clots resolution take place in 4?5 days as well as the B.P. back to normal level.
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