Prenatal sonographic diagnosis of uterine rupture following open fetal surgery

Background: Reported cases of uterine rupture diagnosed by ultrasound have shown fetal membranes ballooning through uterine rupture sites, or adjacent areas of hemorrhage. Case: A 27-year-old gravida 3, para 2 had open fetal surgery to repair a fe tal myelomeningocele at 28 weeks' gestation. Her postoperative course was c omplicated by threatened preterm labor and anhydramnios. At 33 weeks' gesta tion, with maternal symptoms of bowel obstruction, ultrasound showed a feta l leg and section of umbilical cord protruding through the uterine wall. Conclusion: Even in the presence of anhydramnios, uterine wall rupture was identified, because ultrasound evaluation of the uterine wall showed prolap sed fetal parts and umbilical cord. Persistent anhydramnios after open feta l surgery should prompt a search for uterine rupture. (Obstet Gynecol 1999; 93:826-7. (C) 1999 by The American College of Obstetricians and Gynecologis ts.).