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Spontaneous Uterine Rupture in a Multigravid Pregnant Woman with Unscarred Uterus on Chronic Steroid Use: A Case Report

Published:April 26, 2020DOI:https://doi.org/10.1016/j.jogc.2020.04.005

      Abstract

      Background

      Uterine rupture in pregnancy is associated with severe maternal and fetal complications. Although it is a rare event, uterine rupture has been associated with certain risk factors. Glucocorticoids are known to weaken skeletal muscles; however, there have been no studies on the effects of chronic steroid use on the uterine myometrium.

      Case

      We present the case of a 40-year-old multigravid woman who experienced a posterior uterine wall rupture on an unscarred uterus. She was on chronic glucocorticoids for the treatment of psoriatic arthritis. We hypothesize that the catabolic effects of glucocorticoids on skeletal muscles also weakened the uterine myometrium, leading to a higher risk of uterine rupture.

      Conclusion

      Uterine rupture may be associated with chronic use of corticosteroids. Identifying the different risk factors for uterine rupture can lead to more prompt diagnosis and management of uterine rupture, resulting in better maternal and fetal outcomes.

      Résumé

      Contexte

      La rupture utérine pendant la grossesse s'accompagne de graves complications maternelles et fœtales. Bien qu'il s'agisse d'un événement rare, la rupture utérine est associée à certains facteurs de risque. Il est connu que les glucocorticoïdes affaiblissent les muscles squelettiques; cependant, aucune étude ne s'est penchée sur les effets de l'utilisation chronique de stéroïdes sur le myomètre.

      Cas

      Nous présentons le cas d'une femme multigeste de 40 ans qui a subi une rupture de la paroi utérine postérieure sur un utérus non cicatriciel. Elle prenait des glucocorticoïdes sur une base chronique pour le traitement de l'arthrite psoriasique. Nous supposons que les effets cataboliques des glucocorticoïdes sur les muscles squelettiques ont aussi affaibli le myomètre, ce qui a augmenté le risque de rupture utérine.

      Conclusion

      La rupture utérine peut être associée à une utilisation chronique de corticostéroïdes. Le fait de déterminer les différents facteurs de risque de rupture utérine peut favoriser le diagnostic et la prise en charge précoces de la rupture utérine, ce qui améliore les issues maternelles et fœtales.

      Keywords

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