Acute uterine rupture and its sequelae.

A 41-year-old woman developed hypovolaemic shock following instrumental delivery. This was ultimately discovered to be due to uterine rupture. Management involved massive transfusion of crystalloids, colloids and blood products and subtotal hysterectomy and left salpingo-oopherectomy progressing later to bilateral ligation of internal iliac arteries. Resuscitation was complicated by the development of dilutional coagulopathy, cardiac tamponade and cardiac arrest. The patient survived and was discharged from hospital 28 days after the primary event.