Fundal Rupture with Breech Expulsion through it in Primigravida: Role of Destructive Procedure (Decapitation) in Modern Obstetrics

JOURNAL TITLE: Journal of South Asian Federation of Obstetrics and Gynaecology

Author
1. Shalini Singh
2. Sudha Gandhi
3. Vimla Charan
ISSN
0974-8938
DOI
10.5005/jp-journals-10006-1686
Volume
11
Issue
3
Publishing Year
2019
Pages
4
Author Affiliations
    1. Department of Obstetrics and Gynecology, Panna Dhai Mahila Chikitsalaya, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India
    1. Department of Obstetrics and Gynecology, Panna Dhai Mahila Chikitsalaya, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India
    1. Department of Obstetrics and Gynecology, Panna Dhai Mahila Chikitsalaya, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India
  • Article keywords
    Decapitation, Destructive surgery, Fundal rupture, Obstructed labor, Ruptured uterus, Undelivered fetus

    Abstract

    Aim: The aim of the study was to point out the problems faced at peripheral hospitals such as difficulties in assessment and management, and ultimately late referral in inevitable stage, hence increasing risk of maternal mortality and morbidity. The study also discusses the measures to be taken for the betterment, especially in developing countries. Background: Uterus rupture secondary to obstructed labor especially in an unscarred uterus and primigravida is a rare and a life-threatening condition. It needs early detection and prompt management to avoid maternal morbidity, mortality, and stillbirths. Case description: This is a case about 21-year primigravida at term gestation referred to our tertiary hospital from a peripheral hospital in view of an undelivered IUFD baby obstructed at the level of scapula with the head, both arms, and placenta already expelled out and further could not be delivered despite their efforts; peroperatively, it was a fundal rupture through which breech had expelled into abdomen and obstructed. Thus, only destructive procedure of decapitation was the method of choice to deliver the trunk through a ruptured fundus. Conclusion: The patient remained stable throughout the surgery and in the postoperative period, and was discharged on the ninth day in a healthy condition. Clinical significance: The case hold significance because of various challenges faced by us in management and problems at peripheral centers to be handled, better assessment, early referral in order to reduce maternal mortality, and stillbirth in a developing country such as India. We also discuss the significance of destructive procedures in modern obstetrics for developing countries.

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