پارگي رحم در بارداري نولي‌پار با سابقه كورتاژ: گزارش موردي

Rupture of an unscarred uterus in a nullipar pregnant women with a history of curettage: case report

زمينه و هدف: پارگی رحم هنگام بارداری يك عارضه كشنده و مرگ و مير بالايی را برای مادر و جنين به دنبال دارد. شيوع پارگی رحم در افرادی كه اسكار رحمی نداشته‌اند نادر می‌باشد. مهمترين عارضه ديلاتاسيون و كورتاژ سوراخ شدن رحم می‌باشد اما كورتاژ به‌عنوان عامل خطر مهمی برای پارگی رحم مطرح نيست. معرفی بيمار: يك مورد پارگی رحم در بيمارستان جامع زنان تهران در آذر سال 1393در يك زن باردار نولی‌پار با سن بارداری 41 هفته بدون وجود عوامل خطری ازجمله تنگی لگن، جنين ماكروزوم، اسكار و جراحی رحمی گزارش شد. بيمار سابقه حاملگی ناخواسته دو سال پيش از آخرين بارداری و كورتاژ در مطب در سن 9 هفتگی بارداری پيشين را داشت. نتيجه‌گيری: برای كاهش مرگ و مير مادران، بارداری‌های ناخواسته و همچنين دقت بيشتر در اعمال جراحی زنان از جمله كورتاژ در سنين باروری و توجه به سابقه كورتاژ به‌عنوان يك عامل خطر پارگی رحم ضروری به‌نظر می‌رسد.

Background: Rupture of uterus is a catastrophic complication associated with significant maternal and fetal morbidity and mortality. The prevalence of an unscarred uterine rupture is very rare. Although the most important complication of dilatation and curettage is perforation of uterus, dilatation and curettage is not introduced as an important cause of uterine rupture. Case presentation: Here we present a case of uterine rupture in a pregnant woman that was admitted in Tehran General Women Hospital, in December 2014, with reducing fetal movement in her 41th weeks of pregnancy. She did not have any risk factors for rupture of uterus including cephalo-pelvic disproportion and polyhydramnios, also there was no history of uterine surgery such as myomectomy and uterine abnormality repair. A term dead male neonate was delivered by cesarean section due to arrest of descending in stage 2 of labor. The baby weighed 3400 gr and had anomaly in ears, larynx, uvula and soft palate. Its chromosomal study depicted both trisomy and monosomy for chromosome 13 and 21. Mother had a history of illegal curettage and trauma to the uterus in her first pregnancy two years ago. She did not say to us this history and abortion during admission. After cesarean section we saw that in the left side of the posterior wall of uterus was ruptured and baby was died. At surgical exploration, moderate hemoperitoneum was evident. Fetus was already dead at the time of extraction. Total estimated blood loss was 100 ml, the patient was transfused with two units of packed cell. The woman was discharged on the fifth postoperative day in good condition. Conclusion: Effective contraception and safe curettage can reduce maternal mortality and morbidity. Also special attention to a history of curettage to predict uterine rupture is critical.