First Trimester Uterine Rupture: A Case Report and Literature Review

Abstract

The aim is to report a case of spontaneous uterine rupture in the first trimester of pregnancy and to review the literature on the topic. Methods: A literature search was performed using PubMed and Scopus. Relevant English articles were identified without any time or study limitations. The data were aggregated, and a summary statistic was calculated. Results: A 35-year-old gravida 5, para 2 was admitted at our department because of fainting and abdominal pain. The woman had a first-trimester twin pregnancy and a history of two previous cesarean sections (CSs). Suspecting a uterine rupture, an emergency laparotomy was performed. The two sacs were completely removed, and the uterine rupture site was closed with a double-layer suture. The patient was discharged from hospital four days later in good condition. On the basis of this experience, a total of 76 case reports were extracted from PubMed and included in the review. Fifty-three patients out of 76 (69.74%) underwent previous surgery on the uterus. Most women (67.92%) had a CS, and in this group a cesarean scar pregnancy (CSP) or a placenta accreta spectrum (PAS) disorder was found to be the etiology in 77.78% of cases. Furthermore, 35.85% of the women had hysterectomy after uterine rupture. Twenty-three patients out of 76 (30.26%) had an unscarred uterus. Of this group, most women presented a uterine anomaly (43.48%). Moreover, 17.39% of these women had a hysterectomy. Conclusion: According to the literature, the current pandemic use of CS explains most cases of first-trimester uterine rupture.

Uterine Rupture Following a Fall: an Atypical Presentation in a Gravida 2 Patient

“…Indeed, our prompt intervention that involved immediate resuscitation and emergency laporatomy saved this woman's life. We noted similar sporadic reports of relatively similar cases by Gu'eye et al (12), Cecchini et al (13), as well as Halassy, Eastwood and Prezzato (14). Although we notice in all these cases that abdominal pain (no matter the severity) coupled with deranged fetal cardiac activity remain the two most important clinical manifestations.…”

An Exceptional Case of Uterine Rupture on a Scarred Uterus Discovered Following a Late Abortion

“…Rupture in this context is mainly correlated with a specific uterine abnormality, that is, a bicornuate uterus. According to the literature, bicornuate uteri show a particular vascular network between the 2 hemi-cavities, drawing the Greek letter y at the level of the midline [2,10]. One could hypothesize that this type of vascularization weakens the uterine wall, particularly at the level of the uterine fundus, where spontaneous rupture usually occurs.…”

“…A systematic review carried out by Fabiana Cecchini and allin January 2020 [2] summarized all cases of uterine rupture in the first trimester reported in the literature with a number of 76 case reports. She demonstrated that most first trimester uterine ruptures occur in a scarred uterus (69.74%) and that the three main surgeries associated with uterine wall disruption are cesarean section (67.92%), dilation and curettage (28.30%) and myomectomy (9.43%).…”

“…Uterine rupture (RU), which is one of the most serious accidents that can occur during labor or in late pregnancy, contributes significantly to maternal and fetal mortality in developing countries [1]. Most uterine ruptures occur at the end of pregnancy and only a limited number of cases occur during the first or second trimester of pregnancy [2]. Its discovery in post abortion is exceptional.…”

Risk management of vaginal birth after cesarean section (Review)

“…Moreover, the uterine scar rupture can be asymptomatic, which is a challenging situation for the obstetrician in terms of recognition and management. Uterine rupture can happen during labor or during the entire pregnancy (16)(17)(18).…”