Repair of Traumatic Uterine Avulsion of a Gravid Uterus

BACKGROUND: Although the fundus is the most likely location of rupture in the gravid uterus, the isthmus is the weakest point, leaving it vulnerable to avulsion during blunt pelvic trauma. We describe a case of uterine avulsion in a gravid patient that was repaired in an attempt to preserve future fertility.CASE: A 19-year-old primigravid woman in her second trimester presented with uterine body avulsion from the cervix after motor vehicle collision. After evacuation of the pregnancy, repair consisted of circumferential interrupted sutures with digital confirmation of cervical patency. On follow-up imaging, normal anatomy appeared restored, with no residual abnormalities noted. We recommended the use of long-acting reversible contraception postoperatively, as well as special considerations for future pregnancies, such as prelabor caesarean delivery and maternal-fetal medicine subspecialist referral.CONCLUSION: A gravid uterus may be particularly prone to avulsion at the isthmus, and similar techniques as those described previously in cases of nongravid uterine avulsion may be used in an attempt to preserve future fertility.