PMC5750492_01
(a) 2D transabdominal US and color Doppler findings: a loop of umbilical cord was noted outside the uterus and running through the left isthmic uterine wall focal defect. (b) Graphic depiction of the loop of umbilical cord herniated outside the uterus through the left isthmic focal defect. (c) Macroscopic appearance of the uterine rupture at surgery.
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fig1
We performed transabdominal 2D ultrasound that showed an alive intrauterine podalic fetus with normal Doppler flowmetry, oligohydramnios, and minimal intraperitoneal fluid; the patient complained of increasing pain on the left side of the abdomen, where ultrasound revealed the presence of a vascularised area whose venous and arterial flow seemed to be in continuity with the umbilical cord and had the same ultrasound characteristics (Figure 1(a)). This vascularised area was located outside the left wall of the uterus and was likely an early sign of uterine rupture (Figure 1(b)). Surgical findings included a breach running horizontally through the entire anterior wall of the uterus (Figure 1(c)), a moderate quantity of hemoperitoneum, while the fetus had turned so that the left shoulder was facing the abdominal cavity.
PMC5750492_02
(a) 2D transvaginal ultrasound of the IM isthmic myoma type 5. (b) Graphic depiction of the herniated fetus through the isthmic defect on the previous myomectomy scar.
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She, too, had undergone laparoscopic multiple myomectomy 3 years earlier, when two types of myomas were excised: an IM-G5 left isthmic myoma (4 cm) (Figure 2(a)) and a SS-G6 myoma on the fundus (5 cm). Because of the increasing pain, not correlated with fetal expulsion, and of the worsening clinical conditions, we performed transabdominal 2D ultrasound that showed, inside the peritoneal cavity, herniation of the amniotic sac and fetus through the uterine wall along the previous isthmic laparoscopic myomectomy scar (Figure 2(b)).