Therapeutic Mapping after Massive Uterine Rupture as Result of Multiple VBAC (Vaginal Birth after Cesarean Section). A Case Report

Objective: Presentation of a 32-year-old woman (gravida 5, para 5) with massive uterine rupture one week after second vaginal birth at home, after 3 caesarian deliveries. Assiduous discussion concerning birth outcome, delivery complications, optimal treatment and therapeutic management of similar cases.

Case: A 32-year-old multiparous woman was admitted to the emergency department of our hospital complaining of sudden severe abdominal pain, episodes of vomiting and hyperthermia, seven days after second vaginal birth at home and 3 cesarean deliveries in the past. The physical and laboratory examination revealed diffuse septic condition. (WBC:20.000, T:38.5C), Hct: 25,6%. Massive uterine rupture was diagnosed by emergency abdominal ultrasound.

Patient underwent emergency exploratory laparotomy. The aim of this procedure was the clinical certification of uterine rupture and proper management and treatment of the patient.

Critical clinical point is always the procedure of abdominal hysterectomy, in order to restore the rupture complications.

Postoperative course was uneventful. She was discharged from the hospital at the 5th pod in good clinical condition.

Conclusion: Uterine rupture represents the most significant obstetrical complication, often occurring in patients undergoing vaginal birth after prior caesarian deliveries. Due to massive uterine bleeding all these patients must be immediately admitted to exploratory laparotomy/.

Keywords: uterine rupture, VBAC, exploratory laparotomy, hysterectomy.