Doctors at Angers University Hospital in France had never seen this one before. It is only the 26th documented episode of an extremely rare pregnancy complication, a tear in the wall of a 33 year old woman’s uterus, through which her baby’s legs and a large amount of protective amniotic fluid escaped.
The condition was detected when the woman went to the hospital for a routine ultrasound during the 22nd week of her pregnancy. She had no unusual symptoms. The exam found a large herniation of the amniotic sac – the protective membranes that envelop the foetus during gestation. The ultrasound showed that the sac had slipped through a rupture in the left wall of her uterus.
Additional scans via magnetic resonance imaging (MRI) showed that the tear in the uterine wall extended for 2.5 centimetres (1 inch) and a portion of the amniotic sac measuring 19 by 12 by 9 cm (7.5 by 4.7 by 3.5 inches) had slipped through this hole, along with the baby’s legs up to a little above the knees.
Obstetrician and gynaecologist Pierre-Emmanuel Bouet told Sara G. Miller at Live Science that this “extremely rare” condition was something the medical staff at the hospital had never encountered.
The doctors advised the patient that the herniated sac could lead to potentially dangerous complications as the pregnancy developed – including a complete uterine rupture, or the possibility of pre-term birth.
But the woman and her partner decided to proceed with the pregnancy as well as they could, and monitor the situation closely.
According to Bouet, the most likely cause for the rupture was the woman’s earlier history with caesarean sections (C-sections). This pregnancy was the patient’s sixth, with her five previous children all being delivered by C-section.
While the tissue where these C-section incisions were made had healed over and strengthened, areas around the uterus incisions had become weakened, leading to the rupture.
According to doctor Yvonne Bohn from Providence Saint John’s Health Centre in Santa Monica, repeated C-sections are known to carry risks, but they don’t usually present like this.
“It is extremely rare. Usually the risk of rupture [occurs] during labour, but in this case the uterine wall was very weak from prior C-sections,” she told Melissa Willets at Parents.
“The risk of uterine rupture increases exponentially with each C-section,” Bohn added, explaining that the situation can become an issue after three or four C-sections.
Fortunately in this case, the issue didn’t result in the loss of the baby.
Two months after the MRI, with the pregnancy now in its 30th week, another ultrasound showed that the tear had doubled in length to 5 centimetres (2 inches).
As a result, more of the amniotic sac had slipped through the gap, along with more of the foetus’s body – with the abdomen now popping through too.
A decision was made to attempt an early C-section, and at 30 weeks, a healthy baby boy weighing 1.385 kilograms (3 lbs.) was delivered.
After the birth, the woman’s uterine wall and herniated amniotic sac were treated, and the patient was discharged after only five days in hospital.
Six months later, both the mother and her baby were healthy and doing well, so despite the potentially dangerous situation, it all worked out okay. …
Here is the NEJM publication.
While we are on the subject, there may be a much bigger, epidemic level risk of C-sections: they don’t prime the baby’s immune and digestive systems, something that happens naturally during a vaginal birth.
Our current understanding is that in the womb, the gut of the fetus is sterile. Research shows that babies born vaginally have gut bacteria that resembles that in their mother’s vagina. With a C-section, the baby’s bacteria resembles that of the mother’s skin. For example, a C-section baby will lack lactobacillus, a bacteria present in the vagina which aids the digestion of milk.
Lactobacillus species are the most often found inhabitants of vaginal ecosystem of fertile women. In postmenopausal women with low oestrogen levels, Lactobacillus flora is diminishing or absent.
To avoid serious health conditions, including obesity, type 1 diabetes, asthma, eczema and allergies, some women will inoculate the baby by giving it, as soon as possible after birth, vaginal secretions orally and on the skin.
By slathering babies just after birth with a gauze pad that soaked up the microbes in their mothers’ birth canal right before birth.
“… results show that we can partially restore and normalize the microbial assembly that takes place naturally in babies,” says Maria Dominguez-Bello, an associate professor of medicine at the New York University School of Medicine…
Attempts to improve on nature are frequently shortsighted. Our new understanding of the importance of the micro-biome, however, is leading to new therapies for difficult health conditions.
Your body’s microbiome—colonies of various microbes that reside in your gut and elsewhere in and on your body—is as unique to you as your fingerprint, and can be rapidly altered based on factors such as diet, lifestyle, and exposure to toxins and antibiotics.
Getting back to our original story, I wonder if this person, with their unborn legs escaping the mother’s uterus will have any unique feelings or issues as a result. Perhaps they will inexplicably wear legwarmers at all times. This may sound silly or unlikely, but I do wonder how much of our adult experiences result from our pre-birth environment. Did hearing music in the womb make me enjoy music so much now?