In a report published December 21 in the New England Journal of Medicine, Dr. Pierre-Emmanuel Bouet highlights a case unlike anything he has seen in his years as an OB/GYN at Angers University Hospital in France. Indeed, the condition is so rare that there have only been 26 cases ever reported.
A 33-year-old woman had developed a 1-inch tear in the wall of her uterus, and through that tear part of the amniotic sac (measuring 7.5 by 4.7 by 3.5 inches) had popped out. Her baby’s feet could be seen in the sac. The amniotic sac is the fluid-filled membrane found in the uterus that contains the growing and developing fetus.
Astonishingly, the woman had no symptoms and only learned of the condition during a routine ultrasound at the 22-week mark of her pregnancy.
This was her 6th pregnancy. She delivered all five of her babies via caesarean section. Dr. Bouet says that it was those five previous caesareans that elevated her risk for a uterine tear, since the operations had weakened the uterine wall. The tear didn’t occur at the exact location of earlier surgeries, but close by. Regions around the scars were very fragile and the forces and pressures on the uterus that occur naturally during pregnancy led to the tear.
Once the rupture was discovered, the woman and her husband discussed options with the doctors and decided to continue the pregnancy with close monitoring.
Doctors informed the couple of potential risks; additional uterine tearing, preterm birth, and most seriously – a condition called placenta accrete in which the placenta doesn’t detach from the uterine wall after birth.
It was also a possibility that the amniotic sac could rupture. If that happened, doctors would have to perform an emergency c-section but the chances of survival for the baby would be dependent on how quickly they could operate and the age of the fetus.
By 30 weeks the uterine tear had grown by 2 inches and the portion of amniotic sac outside of the uterus was larger as well. This part of the amniotic sac now contained the fetus’s legs and abdomen. Doctors decided they could wait no longer.
The baby was delivered by c-section and following delivery, they repaired the woman’s uterus. She was able to return home after only a 5-day hospital stay.
Her healthy baby boy weighed in at just 3 lbs. Six months later, both mom and baby are reported to be doing well.
