Virginia Research Day 2025

Medical Resident Research Case Reports

21 Uterine Rupture in a Trial of Labor After Cesarean Pregnancy

Hanna Y. Carrasco, DO; Yolanda Paylor, MD Corresponding author: hanna.carrasco@lpnt.net

Sovah Health Family Medicine Residency, Danville, VA

showing worsening variable decels. At 17:46: Sharp abdominal pain radiating to her back, no change in her progression of labor. Significant amount of bleeding and changes in fetal heart tracing and continued variable decelerations down to the 60s; decision was made to proceed with repeat low transverse cesarean section due to concerns for possible uterine rupture. Surgery notable at the time for dense adhesions that were sharp and blunt dissected prior to continuing, as well as a small amount of meconium outside uterus. Patient’s uterine segment was noted by the primary surgeon to be significantly thinner than other areas, as well as a small hole present that was indicative of a small uterine rupture. Infant was delivered

successfully weighing at 3000 grams with APGARs 8+9. Patient required methergine and TXA to aid in bleeding and boggy uterine segment, and patient was explicitly recommended not to proceed with any other TOLACs in the future. Conclusion: I think this case is important because often times even with a low-risk birth proceeding to a TOLAC, it will be largely clinical symptoms as was shown above that clinicians have to watch out for so that both mother and fetus can have the best clinical outcomes for their health.

Case Presentation: 24-year-old G3P1011, 39.2 weeks, SROM at presentation to the hospital. Hx of maternal obesity, GBS positive, anemia, Rh negative status, status post rhogam, varicella non-immune status, history of C-section x1 due to arrest of dilation. Pregnancy complicated by IUGR at 37 weeks; estimated fetal weight of 2647g, 19th percentile. Initial tracing reactive, Category I. Proceeded with TOLAC. Only concerns initially were variable decelerations seen on tracings, with quick recovery. IV fluid boluses were given, with continuation of Pitocin augmentation and Amnioinfusion in the afternoon of day two. Patient started to have pain on day two as well, with IUPC that was placed

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2025 Research Recognition Day