Uterine Rupture due to Traumatic Assisted Fundal Pressure

OBJECTIVE: Uterine rupture is potentially a life-threatening condition for both mother and infant. In this article, we report a rare occurrence of uterine rupture due to traumatic assisted fundal pressure associated with hydrops fetalis and shoulder dystocia. CASE REPORT: A 29-year-old woman was admitted for termination of pregnancy at 34 weeks' gestation because of fetal hydrops. Assisted uterine fundal pressure was done during delivery because of coexistent shoulder dystocia. After a series of assisted uterine fundal pressure, a dead hydropic baby weighing 4,000 g was delivered, and persistent postpartum hemorrhage occurred. An emergency laparotomy was performed, which revealed a large left broad ligament hematoma with multiple bleeding points. The bleeders were safely sutured and the tears of the left lateral uterine wall were primarily restored. The patient was discharged 8 days later. CONCLUSION: Assisted fundal pressure during painful delivery can be traumatic and results in uterine rupture. In this article, we suggest that uterine rupture should be considered whenever a pregnant woman experiences a sudden onset of abdominal pain during the course of assisted uterine fundal pressure.