Uterine Rupture at Term in a Patient With Abdominal Cerclage.

Background: When labor ensues in the setting of transabdominal cerclage, uterine rupture is a potential complication associated with significant morbidity and mortality for both mother and fetus.

Case: A woman with a transabdominal cerclage presented at 39 2/7 weeks of gestation with contractions, tachycardia, abdominal pain, and fetal bradycardia. Emergent cesarean delivery revealed a ruptured uterus with fetus and placenta floating in the abdomen. Neonatal Apgar scores were 2, 2, and 5 at 1, 5, and 10 minutes of life respectively, with cord pH less than 6.8. After transfusion for the mother and rehabilitation for the neonate, both made a good recovery.

Conclusion: Uterine rupture can be catastrophic, and prevention is paramount. In addition to individualized delivery planning, women with transabdominal cerclage in place should be counseled to present to the hospital immediately in the presence of contractions to prevent poor outcomes.