An uncommon case of uterine rupture with retroperitoneal hematoma

Uterine rupture is a serious complication for both mother and child, occurring in 0.2 to 0.8% of attempts at vaginal delivery after cesarean section. A case of 29-year-old Moroccan woman, G2P2, with a previous caesarean section, was admitted to our emergency department at 38 weeks´ gestation for acute fetal distress with complete cervical dilation. The delivery was imminent and done by vaginal route. The uterine revision objectified a uterine rupture. An immediate laparotomy was performed. The surgical exploration revealed uterine rupture on the right uterine edge with vascular pedicle lesion. More, we have found a huge hematoma of the right broad ligament diffusing into the right deep retroperitoneal space. The surgical management consisted of a total hysterectomy and packing of retroperitoneal hematoma. Removal of packing was performed on the fourth day after stabilization of clinical and biological parameters. Fortunately, the evolution was favorable under antibiotic therapy and massive transfusion. The patient was discharged from the hospital on the 10th postoperative day. The baby was doing well without any neurological sequelae.