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Uterine rupture during labor, when it is in the immediate vicinity of the cervix, frequently extends transversely or obliquely. Usually the tear is longitudinal when it occurs in the portion of the uterus adjacent to the broad ligament. We report an unusual case of uterine rupture through posterior vaginal fornix of the posterior lower uterine segment.
Keywords: UTERINE RUPTURE; POSTERIOR VAGINAL FORNIX
CASE
A 37-year-old nulliparous woman with moderate preeclampsia, 32 weeks pregnancy and intrauterine fetal death was admitted to our clinic. On physical examination, the systolic/diastolic blood pressure was 140/100 mm Hg. A moderate peripheral oedema was present. Routine blood and urine analysis were normal. On vaginal examination, it was found that there was no cervical dilatation and effacement and the Bishop score was under 5. With these findings, we decided for immediate delivery. We applied 50 mg intravaginal prostaglandin (misoprostol) every 4 h. Four hours after the second application, effective uterine contractions started. The intensity of the uterine contractions increased all the more after the third prostaglandin application. We evaluated cervical dilatation and effacement via vaginal examination every hour. During the fourth prostaglandin application, cervical dilatation was 0.5 cm, and effacement 25%. Since the intensity of the uterine contractions was enough, we did not use intravenous oxytocin infusion. Also, as the intensity of the uterine contractions was enough, we stopped the prostaglandin...