This report is about a 37-year-old lady referred to ANC at 19-week gestation with a hernia on the right side of her Pfannenstiel incision following two previous Caesarean sections. In previous pregnancies the hernia had been noted but caused no problems.
During this pregnancy the protrusion from the hernia increased in size therefore assessing fetal growth became very difficult. Serial scans were carried out to confirm satisfactory fetal growth. From 28 weeks the hernia seemed to contain most of the pregnancy. An elective CS and tubal ligation was planned at 37-week gestation.
A large protruding hernia meant numerous admissions with abdominal pain. Surgeons were involved to rule out bowel herniation. However due to this and the development of obstetric cholestasis, the elective section was carried out through a midline incision at 36 weeks. The section revealed a large portion of the uterus protruding through a hole in the rectus sheath on the right side. The hernia was repaired immediately following the section by a general surgeon with a near and far interrupted sheath suture. Mum and baby were discharged on the seventh postoperative day, with continued physiotherapy, surgical and obstetric input.
Herniation of a gravid uterus through an anterior abdominal wall is very rare. The risk to both maternal and fetal health is high. Complications documented in literature include preterm labour, intrauterine growth restriction, uterine rupture, spontaneous abortion, strangulation and abdominal wall ulceration. A successful outcome is resolved by good antenatal care, planning and joint care with surgeons.
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