Spontaneous rupture of the uterus is spoken of by writers of text-books on obstetrics and by those who from time to time have recorded such cases, as one of the most fearful accidents of pregnancy. Although it is an extremely infrequent occurrence, it is seen often enough to be constantly borne in mind by those attending women at childbirth.When one finds in a cursory review of the literature for the past few years, upwards of 100 such cases, one appreciates that to the individual writer it is unusual enough to record, and one also appreciates that if as many can be found so reported, it is probably more common than generally supposed. For the sake of clearness it has seemed wise to divide spontaneous rupture of the uterus into those occurring during pregnancy and those occurring during labor. Spontaneous rupture of the uterus during pregnancy is, of course, much less frequently seen than that occurring during labor. However, in 1903 Baisch1 collected 79 such cases from the literature, and in 1923 Kane2 reported 26 additional cases, including one of his own.The great majority of uteri that rupture spontaneously during pregnancy rupture because of gross anatomical uterine abnormalities. Interstitial pregnancies, ruptures of Cesarean section scars, bicornuate uteri are by tar the most frequent causes. In those showing no gross anatomical lesion the rupture has been attributed to hyaline degeneration of the uterine muscle, invasion of the uterine muscle by fetal elements, and by extensive round-cell infiltration, which predispose friability. The majority of these cases occur in multiparae, a few in primiparae.The element of trauma and infection incident upon previous pregnancies, following curettage and the removal of the adherent placenta, are put down as causes of hyaline degeneration in these multiparous uteri. In primiparae the rupture is usually associated with the infantile uterus, whose walls by the dilatation of pregnancy get thinner and thinner, and rupture because they can distend no further.Spontaneous rupture of the uterus during pregnancy may occur at any part of the upper segment of the uterus. Ruptures are found on the anterior wall, the posterior wall, at the fundus, but never in the lower segment. The patient presents the picture of an acute abdomen. A perfectly well woman during her pregnancy may be seized without warning by a sudden acute pain in the lower abdomen. The abdomen is spastic and tender, so tender that attempts to carefully make out the uterus may be entirely unsuccessful. She may be the picture of hemorrhage and she may not. The picture of hemorrhage may be the salient point. In other cases the loss of blood is so slight that it does not attract attention, and, in fact, it is not known that the uterus has ruptured until some time later, when the abdomen is opened and the true cause found. There may be a rise in temperature. Shifting dullness is usually not made out. The most accurate diagnosis that can usually be made is that of a surgical belly. The picture of an appendix abscess, a ...
