A Postpartum Uterine Dehiscence in a Pregnant Woman with Brucellosis; A Cases Report
A uterine dehiscence in a brucellosis case
DOI:
https://doi.org/10.69614/ejrh.v15i2.631Abstract
Introduction
Uterine Dehiscence (UD) is a rare complication and very dangerous complication of cesarean section (CS). Brucellosis is a threatening infection in pregnant women with severe obstetrics outcomes such as spontaneous abortion, premature delivery, intrauterine infection. We presented a case with preterm delivery with continuing high fever due to uterine fascial dehiscence after CS, who were infected to brucellosis.
Case: A 26-year-old woman with gravidity 1, referred to the obstetrical department at 30 weeks of gestation due to Preterm Premature rupture of membranes (PPROM). After vaginally sonography, the patient underwent emergency CS due to fetus FHR drop and umbilical cord prolapse. From second day after CS, the patients fever increased and Doppler sonography shows low fluid and hematoma in the uterus and evidence in favor of a lesion collection that was evacuated with laparotomy and uterine fascial dehiscence was detected. Moreover, wound debridement conducted and during laparotomy the adhesions were released. The Wright-Coombs 2ME test showed she was infected to brucellosis.
Conclusion:
Uterine fascia dehiscence in lower uterine segment incision is a rare but is a potentially dangerous for mothers. However, preterm deliveries due to PPROM and high uncontrolled fever after CS, are conditions that practitioners should considering the uterine dehiscence to their differential diagnoses. Nevertheless, the occurrence of dehiscence due to brucellosis infection is questionable and require more evaluation.
References
1. Klemm P, Koehler C, Mangler M, Schneider U, Schneider A. Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound. Journal of perinatal medicine. 2005;33(4):324-31. Epub 2005/10/07. doi: 10.1515/jpm.2005.058. PubMed PMID: 16207118.
2. Ramadan MK, Kassem S, Itani S, Sinno L, Hussein S, Chahin R, et al. Incidence and Risk Factors of Uterine Scar Dehiscence Identified at Elective Repeat Cesarean Delivery: A Case-Control Study2018.
3. Wagner MS, Bédard MJ. Postpartum uterine wound dehiscence: a case report. J Obstet Gynaecol Can. 2006;28(8):713-5. Epub 2006/10/07. doi: 10.1016/s1701-2163(16)32236-8. PubMed PMID: 17022911.
4. Haridas M, Tenneti VJD, Joshi A. Uterine Dehiscence: A Rare Cause of Postpartum Puerperal Sepsis. Cureus. 2021;13(9):e18264-e. doi: 10.7759/cureus.18264. PubMed PMID: 34722045.
5. Larsen JV, Janowski K, Krolilowski A. Secondary post partum haemorrhage due to uterine wound dehiscence. Cent Afr J Med. 1995;41(9):294-6. Epub 1995/09/01. PubMed PMID: 8591641.
6. Sengupta Dhar R, Misra R. Postpartum Uterine Wound Dehiscence Leading to Secondary PPH: Unusual Sequelae. Case reports in obstetrics and gynecology. 2012;2012:154685-. Epub 2012/06/07. doi: 10.1155/2012/154685. PubMed PMID: 22720176.
7. Baba T, Morishita M, Nagata M, Yamakawa Y, Mizunuma M. Delayed postpartum hemorrhage due to cesarean scar dehiscence. Arch Gynecol Obstet. 2005;272(1):82-3. Epub 2005/05/24. doi: 10.1007/s00404-004-0662-6. PubMed PMID: 15909191.
8. Liu Z, Wei D, Li Y, Zhou H, Huang D, Guan P. Different Clinical Manifestations of Human Brucellosis in Pregnant Women: A Systematic Scoping Review of 521 Cases from 10 Countries. Infection and drug resistance. 2020;13:1067-79. doi: 10.2147/IDR.S248779. PubMed PMID: 32341659.
9. Alsaif M, Dabelah K, Featherstone R, Robinson JL. Consequences of brucellosis infection during pregnancy: A systematic review of the literature. International Journal of Infectious Diseases. 2018;73:18-26. doi: https://doi.org/10.1016/j.ijid.2018.05.023.
10. Bosilkovski M, Arapovi? J, Keramat F. Human brucellosis in pregnancy - an overview. Bosnian journal of basic medical sciences. 2020;20(4):415-22. doi: 10.17305/bjbms.2019.4499. PubMed PMID: 31782698.
11. Sholapurkar SL. Etiology of Cesarean Uterine Scar Defect (Niche): Detailed Critical Analysis of Hypotheses and Prevention Strategies and Peritoneal Closure Debate. Journal of clinical medicine research. 2018;10(3):166-73. Epub 2018/01/26. doi: 10.14740/jocmr3271w. PubMed PMID: 29416572.
12. Treszezamsky AD, Feldman D, Sarabanchong VO. Concurrent postpartum uterine and abdominal wall dehiscence and Streptococcus anginosus infection. Obstetrics and gynecology. 2011;118(2 Pt 2):449-51. Epub 2011/07/20. doi: 10.1097/AOG.0b013e31821619e9. PubMed PMID: 21768850.