(NEJM.com, Pierre-Emmanuel Bouet, Centre Hospitalier Universitaire d’Angers, Angers, France)
A French woman and her baby have survived one of the rarest pregnancy disorders in the history of medicine, much to the astonishment of her doctor, who couldn’t believe what he was seeing when he looked at an ultrasound and saw the fetus’ legs sticking out of a tear in the side of the mother’s uterus.
According to the Washington Post, doctor Pierre-Emmanuel Bouet discovered the rupture during a 22-week anatomy scan, and when he saw those little feet sticking out the side of his patient’s uterus, he said his first reaction was to get some other doctors to come tell him he wasn’t seeing things.
An MRI confirmed that an inch-long rupture had been torn into the woman’s uterus, and the fetus’ legs were sticking out through the hole, though the fetus was still encased in its fluid-filled sac. The sac was outside too, looking on the scan like a giant inflated balloon with two tiny feet in it.
The Washington Post reports that there are only 26 other cases of something like this happening in medical history. A tear in the wall of the uterus is obviously a huge problem for a pregnancy. There would normally be a dangerous amount of internal bleeding, but in this case the woman had no symptoms because the position of the fetus’ legs and the amniotic sac had compressed the tear so it wasn’t bleeding. The woman had no symptoms at all until it was discovered on a scan.
Bouet and co-author Dr. Charlyne Herondelle wrote about the case for the New England Journal of Medicine, and they explain that the rupture was not caused by the fetus’ legs tearing a hole in the uterus. They wrote that the rupture was probably caused by a build up of scar tissue, because the mother had had five other children delivered by C-section, and that the resulting scar tissue had left parts of the uterine wall less able to expand with her most recent pregnancy. The uterus stretched where it could, and then finally ruptured. When the fetus’ feet found the hole, they went through it because there was more room in that direction.
Bouet says he recommended that the pregnancy be terminated, because it was extremely dangerous to proceed with a ruptured uterus. If it ruptured further, there could be sudden and massive amounts of internal bleeding. It was risky for the fetus, too, because there was an extremely high risk of preterm delivery.
In spite of the danger, the mother and her partner decided not to terminate the pregnancy at 22 weeks. They waited it out for eight more weeks with intensive, regular monitoring, and at 30 weeks the baby was delivered by C-section. The baby was premature, but otherwise fine. The mother was out of the hospital just five days later. That was six months ago, and the mother and baby are reportedly doing just fine.