A Case Report: Change in Fetal Heart Rate Pattern on Spontaneous Uterine Rupture at 35 Weeks Gestation after Laparoscopically Assisted Myomectomy

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Abstract
A 31-year-old nulligravid woman who underwent laparoscopically assisted myomectomy 5 months before becoming pregnant suffered uterine rupture at 35 weeks gestation. A 50 g intramusclar myomatous node had been removed laparoscopically. Early signs of rupture included sudden onset of severe abdominal tenderness and frequent uterine contractions despite reassuring FHR tracing. Variable deceleration was observed as late as 7.5 hours after onset. Emergency cesarean section was performed due to increasing severity of tenderness, revealing complete uterine rupture at the fundus site without extrusion of the fetus or placenta. A male neonate (2,860 g) was delivered without asphyxia and an Apgar score of 8. Total volume of hemorrahge was approximately 50 ml. The ruptured uterine wall was repaired by suturing in 2 layers. The present case indicates that sudden onset of abdominal tenderness in pregnant women with a history of laproscopic myomectomy may suggest uterine rupture even in the presence of reassuring FHR. This is a rare case, as non-reassuring FHR patterns generally appear in the late stages of uterine rupture.

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