Case 34-2012: Severe Pain, Bleeding, and Shock during Labor

New England Journal of Medicine (Impact Factor: 55.87). 02/2013; 368(8):777-8. DOI: 10.1056/NEJMc1214823#SA1
Source: PubMed


To the Editor: The description in the Case Record by Getahun et al. of uterine rupture during labor (Nov. 8 issue)(1) raises awareness about the possibility of this catastrophic event, which occurs far too often in low-resource settings, even when obstetric services are available.(2) Uterine rupture occurs almost exclusively in multiparous women, often with prolonged labor. In nulliparous women, neglected obstructed labor is more likely to result in a vesicovaginal fistula. We have witnessed women in whom a fistula developed in their first pregnancy and ruptured the uterus in a subsequent pregnancy. The use of partography is essential in the . . .

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