A 31 Year Old Female’s Uterine Ruptured | Near Miss Case 2

In our previous article, we read how Dr. Achala Vaidya and her team helped survive a 22-Year-Old Female Fighting a Near-miss Case. This article is regarding another Near-miss case handled by the best gynaecologist doctor in Kathmandu, Dr. Achala Vaidya herself and her team.

This case is all about a 31 Years Old Female patient suffering from uterine rupture in a gasping state. Let’s look at this case and learn about Dr. Achala Vaidya and her team operating on this patient and giving her a new life.

Near-Miss Case 2 

We present a case of Mrs GB, referred from the peripheral hospital, 31 years old, G4P2L1A1  at 34 weeks +1 day with uterine rupture in gasping state came to ER on 17th October 2017.

On arrival, she did not have recordable BP and no peripheral pulses palpable. History taken from guardian suggested, that this is her fourth pregnancy with one living issue by CESAREAN SECTION done at Dhulikhel hospital 6 years back, and one previous uterine rupture at term with IUD  gestation two years back after induction of labour use of prostaglandin vaginally and one pregnancy had medical termination. 

She had regular pregnancy checks at the peripheral hospital where ultrasound was done at regular intervals and the latest was at 20 weeks of gestation. There was no history of trauma or any injury or loss of consciousness.

She complained of pain abdomen 3 to 4 hours early with decreased fetal movements with no vagina bleeding, for which she was taken to another hospital where her condition deteriorated and was rushed to the emergency ward.

On presentation, she had no recordable BP and peripheral pulse, hypoxic with oxygen saturation of 70% in room air, disorientated with GCS 10/15. She was pale and had cold and clammy extremities.
On abdominal examination, the abdomen was distended, fetal parts were easily palpable with the uterus being palpable separately at the right lower abdomen, and no fetal heart sounds were heard. 

On vaginal exanimation, so was closed and no presenting part was felt. The resuscitation with a team of anesthesiologists and emergency medicine was done with two large bores 14 gauze cannula obtained blood for full blood count, coagulation studies, typing and cross match and IV colloids and crystalloids.

4 units of whole blood and 2 units of FFP  were secured. After taking high-risk consent from the patient’s guardian. Emergency laparotomy with subtotal hysterectomy under general anaesthesia because of uterine rupture. Her preop Hb was 4gm%. 

During surgery, a paramedian incision was given, we found that there was hemoperitoneum estimated at 4000 ml and the uterus was completely toned at the left lateral wall from the fundus to a supracervical area with active bleeding from margins which was the site for the previous rupture, the lower segment caesarean scar was intact, bladder anatomy was intact but it was advanced to lower uterine segment due to previous caesarean section.

The fetus was found in the peritoneal cavity along with the placenta.
We carried out Subtotal Hysterectomy and peritoneal toileting. The fetus was female weighing 2500gms. The patient has transfused 2000 ml of whole blood during surgery. She was transferred to the intensive care unit where she was extubated the next day 18th October 2018.

She received a total of 14 pints of blood and blood products from 17 to 20th October (4 whole blood,3 fresh blood, 4 PACKED CELL AND 3 UNITS OF FFP). She remained in hospital at the department of obstetrics and gynaecology for the next 15 days, stitches were removed and on discharge, her Hb was 11.2gm%. The patient was discharged with hematinics and vitamins. 

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