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Rupture of uterine is an important side effect of pregnancy for health policy in developing countries. It is a rare event that causes maternal mortality and fetal morbidity. A 27-year old woman in the gestational age of 23 weeks who was admitted to the hospital because of a vague abdominal pain for 5 days. Her previous ultrasound which was done two weeks later reported as an intrauterine fetus with normal umbilical cord and normal volume amniotic fluid. There was no sign of ectopic pregnancy. The patient recommended being evaluated by abdominal and pelvic magnetic resonance imaging with/without gadolinium. Magnetic resonance imaging (MRI) results showed normal position of the uterus opening in the cesarean scar. In subhepatic tissue, single fetus in transverse position on the anterior bowel loops was evident. On the serosal surface of the uterine fundus, a mixed signal with a size of 125×95 millimeters in favor of placenta was seen. After resuscitation with intravenous fluids, the patient was prepared for surgery. Emergency laparotomy was done. The patients with abdominal pain and vaginal bleeding during pregnancy who have this risk factor should be mentioned for uterine rupture as a critical differential diagnosis if the diagnosis is confirmed they should be a candidate for emergency laparotomy and massive transfusion and fluid resuscitation.

Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. Recently cesarean section delivery has been raised around the world markedly; therefore women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual Spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs have been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently. How to cite this article Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. Donald School J Ultrasound Obstet Gynecol 2014;8(3):311-315.

Aim: This systematic review is planned to analyse the studies investigating the uterus rupture complication in women who gave a vaginal birth after caesarean section. Research Question: What is the incidence of uterus rupture during a vaginal birth after caesarean section in women under the age of 35 with a single fetus under 4000 gr and a history of caesarean section? Databases: Google Scholar, National Academic Network and Information Centre, Pubmed. Method: 4305 results, published between the dates of 2008 and 2011 and obtained through an electronic search from Google Scholar and National Academic Network and Information Centre, were reviewed between the dates of 18 and 23/12/2012. Summaries of 103 results, which were free of charge and could be obtained in full text, out of 588 results obtained as a result of the search from Pubmed database were reviewed. Five articles from these articles which provided the rate of uterine rupture in vaginal birth after caesarean section were included in the scope of the study. Findings: Studies, included in the scope of the review, determined that the majority of women were under the age of 35. It was figured out that the rate of vaginal birth in women with a history of a previous caesarean section varied from about 34% to 95% and the rate of uterus rupture in these births was 0.9%. Conclusion: Vaginal birth after a caesarean section is considered as a practicable and acceptable method for carefully selected cases, in clinics with adequate equipment and good care conditions, with the approval of families. Ozet Amac: Bu sistematik inceleme, sezaryen sonrasi normal vajinal dogum yapan kadinlarda uterus ruptur komplikasyonunu inceleyen calismalari analiz etmek amaciyla planlanmistir. Arastirma Sorusu: 35 yas alti, tahmini 4000 gr altinda ve tek fetus olan, tek sezaryen gecirmis olan kadinlarda, sezaryen sonrasi vajinal dogumda uterus rupturu gorulme oranlari nedir? Veri Tabanlari: Google Akademik, Ulusal Akademik Ag ve Bilgi Merkezi, Pubmed. Yontem: 18-23/12/2012 arasindaki tarihlerde, 2008-2012 yillari arasinda yayinlanmis olan, Google Akademik ve Ulusal Akademik Ag ve Bilgi Merkezinden yapilan e lektronik arama ile 4305 adet sonuc incelendi. Pubmed veri tabaninda yapilan aramada 588 adet makaleden, ucretsiz ve tam metin alinabilen, dili Ingilizce olan 103 adet sonucun ozetleri incelenmistir. Bu makalelerden sezaryen sonrasi vajinal dogum uygulamasi yapilan, uterus rupturu oraninin verildigi bes adet makale calisma kapsamina alinmistir. Bulgular: Inceleme kapsamina alinan calismalarda kadinlarin cogunlukla 35 yasin altinda oldugu belirlenmistir. Onceden sezaryen olan kadinlarda vajinal dogum oraninin yaklasik %34 ile %95 arasinda degistigi ve bu dogumlarda uterus rupturu oranini en fazla %0.9 oldugu gorulmustur. Sonuc: Sezaryen sonrasi vajinal dogum, dikkatli secilmis olgularda, anne icin yeterli donanim ve iyi bakim kosullarinin oldugu kliniklerde, ailenin de onayi alinarak uygulanabilir ve kabul edilebilir bir yontem olarak gorulmektedir.

Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. We aimed to depict various types of niche imaging by sonohysterography. Recently, the rate of cesarean section delivery has markedly risen around the world; therefore, women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Various shapes of uterine cesarean scar defects (niche) in TVS and SHG include: thin linear defect, wedge shape defect, droplet defect, semicircular defect, rectangle defect, inclusion cyst defect, irregular defect, multiple defects. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs has been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently.

OBJECTIVE In the presented paper, obstetrical management after previous caesarian section was studied in a large patient collective at the University Department of Gynaecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of rupture of the uterus. PATIENTS From a total of 15,166 deliveries, 1,086 of the births had been preceded by one or more caesarian section. These 1,086 births formed the patient collective for the present study. RESULTS Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. If there had been a previous caesarian section, the percentage shifted in favour of vaginal delivery. All patients with more than two previous caesarian sections were delivered by a primary caesarian section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for primary (11.5%) or secondary resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery. CONCLUSION This retrospective study confirms the general recommendation of vaginal delivery following previous caesarian section as long as risks are minimized by a readiness to proceed with resectioning when signs of imminent rupture of the uterus arise.

During 3 year period there were over 20 000 deliveries at the Institute for Gynecology and Obstetrics. Considering the fact that our clinic?s maternity hospital is the largest in the Balkans and that we are at the top of medical practice, the largest number of deliveries in Serbia and Monte Negro is performed in our institution. For the number of uterus ruptures dramatically increased, we analyzed the way of their repair and possible measures for preventing postpartum hysterectomies. We compared patients with performed hysterectomies or uterus sutures. We analyzed the possibility to approach more conservatively to such complications. 30 patients were subjected to interventions. In the group A there were 25 women subjected to more conservative therapy. In the group B there were 5 patients with total hysterectomy with conservation of one or both adnexes.

The authors report a case of spontaneous uterine rupture in a patient with no risk factor. The break was initially silent and incomplete. Then, because of profuse bleeding was subjected to subtotal hysterectomy and is now in good health. Histological examination revealed severe dysplasia with necrosis of the coating of the esocervix . The authors conclude by stressing the importance of diagnostic assessment of the cervix in pregnancy is to prevent cervical cancer, to eliminate a rare risk factor for uterine rupture during labor.

Background: The incidence of uterine rupture is high in most developing countries and it is a leading cause of maternal mortality and morbidity. Objectives:To determine the incidence, aetiology and the associated morbidity and mortality in cases of ruptured uterus presenting at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Materials and Methods: A review of all the case notes of patients that were managed for uterine rupture over a 7-year period was conducted. The records were analysed for the patients' mode of presentation, possible predisposing factors, type of uterine rupture, and the associated morbidity and mortality. Results: The incidence of rupture during the period was 1 in 67 deliveries or 14.9 per 1000 deliveries. The mean age [SD] was 30.1 [1.8] and the mean parity was 3.3 [0.93]. Majority (88.5%) of the patients were unbooked. Oxytocin administration was the identified aetiological factor in 41 (67.2%) of the patients. Majority (73.8%) presented with clinical signs of shock. At operation, 56 (91.8%) were found to have complete uterine rupture, with a predominance of anterior wall rupture (83.6%). Uterine repair with or without bilateral tubal ligation was the usual surgical treatment offered while wound sepsis, with or without generalized septicaemia, was the commonest morbidity found. Maternal mortality was 14.8%. Conclusion: Uterine rupture continues to be a major cause of maternal morbidity and mortality in Sagamu and efforts should be geared towards reducing the number of women affected by this problem. Key Words: Uterus Rupture, Genital Injury, Haemorrhage, Shock [Trop J Obstet Gynaecol, 2003, 20: 137-140]

In the work presented here, obstetric management after a previous caesarean section was studied in a large patient group at the University Department of Gynecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of uterine rupture. From a total of 15 166 deliveries, 1086 of the births had been preceded by one or more caesarean sections. These 1086 births formed the basis for the present study. Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. Where there had been only one previous caesarean section, the percentage shifted in favor of vaginal delivery. All patients with more than two previous caesarean sections were delivered by elective caesarean section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for elective (11.5%) or emergency resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery. This retrospective study confirms the general recommendation and safety of vaginal delivery after a previous caesarean section as long as risks are minimised by a readiness to proceed with a repeat caesarean when signs of imminent rupture of the uterus arise.

A spontaneous uterus rupture occurred during the labour of a 37-week-pregnant woman showing a precocious rupture of membranes. It appeared enlarged and the cut surface of the myometrium showed coarse trabeculations. The histological examination showed a hypertrophic gravidic myometrium with heterogeneous areas of fibrosis and adenomyosis, necrotic decidual foci and hyperplastic cervical canal glands. Our experience suggests that a silent and spontaneous uterine rupture, is possible even in the absence of the principal risk factors.

We present a case of uterine rupture at the 33th gestational week who underwent a successful uterine septum resection by operative hysteroscopy two years ago. Recently, hysteroscopic septum resection has become the first choice of treatment in septate uteris. Uterine rupture in pregnancy is not an expected complication. We report an unusual case of uterine rupture following an uncomplicated hysteroscopic procedure.

A year after a fundal myomectomy performed as day surgery, a 39-year-old primigravida presented with complete uterine rupture at 36 weeks of gestation. A dead female baby was found lying below the diaphragm and a lot of blood was found inside the abdominal cavity. The uterus was repaired. A year later, another spontaneous pregnancy ensued. A healthy female baby weighing 2100g was delivered by elective cesarean section at 34 weeks. Careful hospital management and scheduled elective cesarean delivery could be a way of achieving a favorable outcome.

Thirty-six cases of obstetrical rupture of the uterus over a thirty-two-year period at the Woman's Hospital are presented. As over half of these ruptures occurred in patients who had previously been delivered by cesarean section, it therefore seems wiser to pursue a policy of “once a cesarean, always a cesarean.” Granted that some patients with adequate pelves may safely be delivered vaginally following previous cesarean section, this fact, nevertheless, should not give one a sense of false security, as it is no guarantee that the uterus of such a patient will not rupture during a subsequent labor. Other predisposing factors such as previous myomectomies and complicated vaginal deliveries are also discussed and certain recommendations made.

In the 34 years from 1929 to 1962, inclusive, there were 35 cases of rupture of the uterus during pregnancy at the Pennsylvania Hospital. The series is classified according to etiologic factors and is reviewed from the standpoints of age and parity of the patients, time and site of rupture, causes, diagnosis, treatment, and maternal and fetal mortality. The adoption of less traumatic procedures for termination of labor has reduced the incidence of non-cesarean uterine rupture. Gratifying results have been achieved in management of post-cesarean uterine rupture in recent years; during the second half of the 34 year period there were no maternal or fetal deaths in this group.

A case report is presented of a patient operated upon for partial separation of the normally implanted placenta. Massive hemorrhage (3,000 c.c.) occurred within a matter of three minutes after opening the uterus. The placenta had to be removed manually, and it would appear that the uterus was unknowingly ruptured during this procedure. The initial measured blood loss was in excess of one-half the estimated blood volume, and simultaneous replacement of blood and plasma by multiple transfusions during the day of operation represented eight-ninths of the estimated blood volume. The calculated blood volume of the patient at the time of operation was 6,200 cubic centimeters. The total blood loss was estimated at 5,700 cubic centimeters and the replacement of blood and plasma amounted to 7,750 cubic centimeters.

In der Zeit von 1906–1954 wurden an der Landes-Frauenklinik Bochum unter 45183 Geburten 44 Uterusrupturen beobachtet. Das entspricht einer Frequenz von 0,097%.

Two cases are here reported, which were strikingly similar except that, in the second, the bladder itself did not rupture but acted as a tampon to the tear in the uterine lower segment, while, in the first case, rupture of the lower segment into the bladder took place. The second patient had been unwisely allowed to remain in hard labor for several hours before the consultant was called, and rupture had taken place when the patient was first seen by the author.