European Journal of Obstetrics & Gynecology and Reproductive Biology
Case reportUterine rupture after a single vaginal 2 mg prostaglandin gel application in a primiparous woman
Introduction
The intravaginal prostaglandin gel, Prostin E2 (Pharmacia and Upjohn) is widely used and thought to be relatively safe in cervical ripening and induction of labour [1]. We report a case of hyperstimulation and subsequent uterine rupture following its application in a nullipara.
Section snippets
Case report
A 26-year-old para 0 was admitted for induction of labour. She was 41 weeks and 4 days pregnant. She had an uneventful antenatal period. Clinical examination was normal the cervical Bishop score was 2. Following a reassuring 40 min pre-prostin cardiotocographic (CTG) monitoring, 2 mg of Prostin E2 gel was inserted into the posterior fornix. A subsequent 1 h CTG trace remained normal.
About 2 h later, she developed hyperstimulatory uterine contractions. Unexpectedly, this was associated with severe
Discussion
Uterine rupture is a rare event in the developed world. In the UK in 1994–1996, uterine rupture caused five maternal deaths. In two of the five deaths, drugs had been used to induce labour [2]. Prostaglandins have been associated with uterine rupture when they are used in the presence of risk factors such as uterine scar and multiparity [2]. This patient had no such pre-disposing risk factor. She was a nullipara and to the best of our knowledge, this is the first case of a prostaglandin-induced
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