Silent uterine rupture: Resident's dilemma and lessons learnt

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Author: M. Tigga
Date: April-June 2019
From: Journal of Postgraduate Medicine(Vol. 65, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Case study
Length: 700 words
Lexile Measure: 1520L

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Byline: M. Tigga

A 36-year-old female with G7P6L6 at 36 weeks of gestation presented with complaints of vague pain abdomen and decreased perception of fetal movement since morning, accompanied by an episode of minimal bleeding per vaginum. There was no history of trauma and no prior antenatal checkups or investigations were done. On examination, she had mild pallor, pulse was 86/min and blood pressure was 110/70 mm of Hg. Her abdominal examination revealed 36 weeks sized uterus with maintained contour, absent fetal heart sound, no tenderness, and without superficial palpable fetal parts. A per speculum examination was done suspecting the possibility of placenta previa, which revealed no active bleeding. An emergency ultrasonography reported intrauterine fetal demise and placenta completely covering os. Her investigations showed: hemoglobin 8.8 gm/dl, hematocrit 30%, and normal coagulation profile and platelet count. The patient was diagnosed as type 4 placenta previa with intrauterine fetal demise and posted for cesarean section. It came as a bolt from the blue when intact amniotic sac with fetus en-caul was found extruded into the abdominal...

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Gale Document Number: GALE|A584164894