SPONTANEOUS UTERINE RUPTURE RELATED TO EXCEPTIONAL RARE "TWIN PREGNANCY" - TROPHOBLASTIC PATHOLOGY AND ONGOING PREGNANCY
Abstract
Background: The peritoneal bleeding in intrauterine ongoing pregnancy is a serious event that poses problems of identifying and stopping the source of bleeding, long-term impact of hypovolemia, anemia, operative, anesthetics, imaging acceptance.
The purpose of the study: to highlight the very special circumstances and therapeutic strategies to treat a complicated "twin pregnancy"
Matherial and methods: Case presentation, 25 years old women (14-16 weeks ongoing pregnancy),arriving ED accusing abdominal pain, vomiting and a diarrheal stool from 3-4hours. Initially, hemodynamically stable, without fewer, with seemingly normal development of pregnancy, without free intraperitoneal fluid or vaginal bleeding, but uterine hypertonia. During ED surveillance gradually develops of an active intraperitoneal hemorrhage syndrome, uterine painful contractions and tenderness in the lower abdominal floor. No family agreement for abdominal invasive imagistic. At 2h extreme fetal bradycardia, progressive hemorrhagic shock, peritoneal fluid.. Laparatomy decided - extended uterine rupture with fetus expelled in peritoneal cavity and massive hemoperitoneum. Uterine structure modified by placental-site trophoblastic tumors. Balloon tamponade and hysteroraphyis.
Conclusions:
- A "twin pregnancy"(a GTD coexisting with a fetus) is exceptional for placental-site trophoblastic tumors type of GTD
- Spontaneous uterine rupture at this age of pregnancy is exceptional but evolving dramatic gravity, and fetus compromised
Downloads
References
2. Kohorn EI (2001). The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. Int. J. Gynecol. Cancer11 (1): 73–7. doi:10.1046/j.1525-1438. 2001.011001073 \.x.PMID 11285037.
3. Gestational Trophoblastic Tumors Treatment - National Cancer Institute. Retrieved 2010-03-21.
4. Sebire NJ (2010). Histopathological diagnosis of hydatidiform mole: contemporary features and clinical implications. Fetal Pediatr Pathol 29 (1): 1–16.
5. Lee SW, Kim MY, Chung JH, Yang JH, Lee YH, Chun YK (February 2010). Clinical findings of multiple pregnancy with a complete hydatidiform mole and coexisting fetus. J Ultrasound Med 29 (2): 271–80. PMID 20103799.
6. Gerulath AH, Ehlen TG, Bessette P, Jolicoeur L, Savoie R (May 2002). Gestational trophoblastic disease. J Obstet Gynaecol Can 24 (5): 434–46. PMID 12196865.
7. True DK, Thomsett M, Liley H, et al. (September 2007).Twin pregnancy with a coexisting hydatiform mole and liveborn infant: complicated by maternal hyperthyroidism and neonatal hypothyroidism. J Paediatr Child Health 43 (9): 646–8. doi:10.1111/j.1440-1754.2007.01145.x.PMID 17688651.
8. Behtash N, Behnamfar F, Hamedi B, Ramezanzadeh F (April 2009). Term delivery following successful treatment of choriocarcinoma with brain metastases, a case report and review of literature. Arch. Gynecol. Obstet. 279 (4): 579–81.doi:10.1007/s00404-008-0753-x. PMID 18726607.
9. Suri S, Davies M, Jauniaux E (2009). Twin pregnancy presenting as a praevia complete hydatidiform mole and coexisting fetus complicated by a placental abscess. Fetal. Diagn. Ther. 26 (4): 181–4.doi:10.1159/000253272.PMID 19864876.
10. Dolapcioglu K, Gungoren A, Hakverdi S, Hakverdi AU, Egilmez E (March 2009). Twin pregnancy with a complete hydatidiform mole and co-existent live fetus: two case reports and review of the literature. Arch. Gynecol. Obstet.279 (3): 431–6. doi:10.1007/s00404-008-0737-x. PMID 18679699.
11. Vandenhove M, Amant F, van Schoubroeck D, Cannie M, Dymarkowski S, Hanssens M (May 2008). Complete hydatidiform mole with co-existing healthy fetus: a case report. J. Matern. Fetal. Neonatal. Med. 21 (5): 341–4.doi:10.1080/14767050801925156. PMID 18446663.
12. Shih IM, Seidman J D, Kurman RJ (June 1999). Placental site nodule and characterization of distinctive types of intermediate trophoblast. Hum. Pathol. 30 (6): 687–94.doi:10.1016/S0046-8177(99)90095-3. PMID 10374778.
13. Lurain JR (January 2011). Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. Am. J. Obstet. Gynecol. 204 (1):11–8. doi:10.1016/j.ajog.2010.06. 072. PMID 20739008.
14. Sebire NJ, Seckl MJ (2008). Gestational trophoblastic disease: current management of hydatidiform mole. BMJ 337: a1193. doi:10.1136/bmj.a1193. PMID 18708429.
15. Berkowitz RS, Goldstein DP (April 2009). Clinical practice. Molar pregnancy. N. Engl. J. Med. 360 (16): 1639–45.doi:10.1056/NEJMcp0900696. PMID 19369669.
16. Basow, DS (Ed). Gestational trophoblastic disease: Management of hydatidiform mole. Garner EIO. In: UpToDate [Textbook of Medicine]. Massachusetts Medical Society, Waltham Wolters Kluwer Publishers, Amsterdam, The Netherlands. 2010.
17. Molina, Vanessa Ventura; Ochoa, Minerva Lazos; Céspedes, Danny Soria. Coriocarcinoma gestacional. Una causa de hemorragia de tubo digestivo alto. Informe de un caso. Revista Medica del Hospital General de Mexico. 2007;70(3): 130
18. Belfort, Paulo; bueno, Luiz Gustavo; novaes, Carlos Eduardo and rezende, Jorge de. Doença trofoblástica gestacional complicada por hemorragia. Rev. Bras. Ginecol. Obstet. [online]. 2004;26 (7):551-6. ISSN 0100-7203.http://dx.doi.org/10.1590/S0100-72032004000700007
19. Kolomeyevskaya NV; Tanyi JL; Coleman NM; Beasley AD; Miller HJ; Anderson ML. Balloon tamponade of hemorrhage after uterine curettage for gestational trophoblastic disease.Obstet Gynecol; 113(2 Pt 2): 557-60, 2009 Feb.
20. Keepanasseril A; Suri V; Prasad GR; Gupta V; Bagga R; Aggarwal N; Dhaliwal LK; Khandelwal N. Management of massive hemorrhage in patients with estational trophoblastic neoplasia by angiographic embolization: a safer alternative. J Reprod Med; 56(5-6): 235-40, 2011 May-Jun.
