Monday, March 13, 2017

Baby's feet stuck out

An MRI revealed a 2.5cm tear of the left uterine wall (arrows) and a large 19cm-long herniation of the amniotic sac, housing the unborn baby’s legs. The 33-year-old mother’s five previous caesarean sections were the most likely cause of the tear, and nota particularly ferocious kick. Oddly, the woman experienced no internal bleeding and was completely asymptomatic. The pressure of the amniocele probably stopped the uterine rupture from bleeding, thus preventing pain. Despite the potential risks, the patient decided to proceed with the pregnancy with close monitoring. At 30 weeks’ gestation, the dehiscence had increased by 5cm and the herniated sac had grown to encompass the fetal abdomen, so doctors opted to deliver the newborn, a healthy male weighing 1.385kg, via caesarean. After delivery, the uterine rupture and amniocele were successfully repaired, and the woman was discharged from the hospital five days later. At six months’ follow-up, the baby boy was alive and kicking.

Source: Bouet P., and Herondelle C,, (2016) Uterine Rupture with Protruded Legs in a Large Amniocele N Engl J Med 2016; December.

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