Relationship between prelabour uterine rupture and previous placenta previa diagnosis: case reports and review of literature

ABSTRACT 

Background. The number of Caesarean sections is growing worldwide, intensifying the
risk of complications in subsequent pregnancies and leading to increased maternal and fetal morbidity and mortality. In particular, the literature shows a higher risk of uterine rupture in subsequent pregnancy with trial of labor after caesarean section. Furthermore, there are few data about pre-labor uterine rupture in scarred uteri.
Objective. Since the key factor for management is timing, the aim of this cases report was to describe the accuracy of prenatal ultrasound of scars in the early determining of pre-labor UR risk in two cases with a previous Caesarean sections during their subsequent pregnancy.
Case presentation. We reported two cases of uterine rupture occurring outside of labour in patients with a history of caesarean section due to placenta previa. In the current cases was reported how a higher hysterotomy, combined with some risk factors, could increase the prevalence of UR in the subsequent pregnancy.
Conclusions. In these cases, a higher uterine incision due to placenta previa or isthmic myoma seems to be correlated with a major risk of UR. Therefore, although in a limit experience, we report that the periconceptional prenatal ultrasound examination of previous cesarian section level could represented a useful predictive factor of pre-labor uterine rupture  in subsequent pregnancies.