Aga Khan medics save life of mother who lost five pregnancies

Although pregnancy is usually a safe and healthy process, it comes at a high cost and suffering for one woman in Nairobi.

She has had six pregnancies. They all came with complications that threatened her own life and resulted in foetus deaths, except in one case.

Her sixth pregnancy has now been recorded as a medical rarity. It was terminated due to a rare uterine rapture at just two months.

Uterine rupture often occurs in the third trimester of pregnancy (from the seventh month) or during labour. Medics say its occurrence in early pregnancy is extremely rare.

Dr Steve Mutiso, an obstetrician-gynaecologist, and his colleagues at the Aga Khan University Hospital in Nairobi said the 39-year-old woman presented last year at week 11 of pregnancy with severe lower abdominal pain that was sharp and continuous. The pain became nearly unbearable in the last four hours.

“She had associated dizziness but no vaginal bleeding. She had a history of four previous hysterotomy scars (scars in the uterus) with only one living child,” the medics reported on Saturday in the Journal of Medical Case Reports.

An ultrasound revealed her uterus was ruptured, and the abdominal cavity was filled with fluid. This is one of the rarest conditions recorded in Kenya.

“First-trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding such as an ectopic pregnancy,” Dr Mutiso and his colleagues reported.

“It can lead to serious maternal morbidity or mortality, which is mostly due to catastrophic bleeding.”

Aga Khan University’s obstetrician/gynaecologist Dr Felix Oindi, and faculty resident Dr Debbie Mundia co-authored the report.

The Aga Khan case is also important because of the medics’ quick intervention, which saved the woman’s life.

She was wheeled to theatre immediately where the open surgery revealed a uterine rupture of approximately 10 centimetres and bleeding of approximately one litre of uterine fluid.

The gestational sac (the fluid-filled structure surrounding the embryo ) was found protruding from the uterus and was expelled. The placenta was also expelled.

The medics washed the cavity and stitched back the rupture in three layers with an absorbable surgical thread.

“There were no intraoperative complications. She recovered well and was discharged on the third postoperative day,” Dr Mutiso and his colleagues said.

Their report is titled, “Uterine Rupture in the first trimester: A Case Report and Review of the Literature.”

The woman's obstetric history revealed her first pregnancy was in 2013, which was complicated by an emergency caesarean section at 28 weeks resulting in neonatal death.

The second pregnancy in 2015 was complicated by high blood pressure. She had an emergency CS at 31 weeks and a neonatal death thereafter. Her third pregnancy was in 2016. She developed high blood pressure and was delivered at 36 weeks via emergency CS due to uterine rupture. The baby survived.

Her fourth pregnancy in 2018 ended in an incomplete miscarriage in the first trimester. Her fifth pregnancy in 2019 ended up with a uterine rupture and a stillbirth at 28 weeks.

Dr Mutiso and his colleagues said ideal management of pregnancy after uterine rupture in the first trimester has not been developed due to insufficient literature.

"But it can be posited that close clinical surveillance will aid in early identification of subsequent ruptures," they said.