Uterine Rupture at 21 Weeks in Twin Pregnancy with TTTS and Previous C-Section
Table 1
Gestational age (weeks)
Symptoms
Physical/plan
12
Pain in her lower abdomen
Ultrasound examination: some free fluid was seen beside the uterus and a small hematoma in the fundus of the uterus. The explanation for the free fluid was thought to be a corpus luteum bleeding.
16
Trauma, fall on right side of her abdomen
In ultrasound examination some free fluid was seen intraperitoneally. Hemoglobin level was 8.85 g/dl.
21 + 2
Presentation with vaginal bleeding
The ultrasound was normal and no signs of TTTS were seen; the cervical length was 15–17 mm.
21 + 3
There was an increase in contractions and pain
A threatening TTTS Quintero stage 1 was diagnosed: fetus 1 showed a deepest vertical pocket (DVP) of amniotic fluid of 79 mm and fetus 2 a DVP 19 mm. Stomach and bladder filling were present in both fetuses and Dopplers were normal. The cervical length was 15 mm. There was not yet an indication for fetoscopic laser coagulation of the vascular anastomosis. Tocolysis with indomethacin was started.
21 + 4
There was minimum of painless brown vaginal bleeding
Ultrasound examination showed signs of TTTS Quintero stage 1, with a DVP of 10 cm in fetus 1 and a DVP of 1.9 cm in fetus 2. Stomach and bladder filling were normal in both fetuses as were the Dopplers. There was an anterior localization of the placenta. Because of TTTS Quintero 1 with cervical shortening a laser procedure was planned for the next day.
