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Abstract

A 31-year-old, gravida 4, para 2, woman presented with acute upper abdominal pain and nausea at 15 weeks' gestation. She had a history of appendectomy during childhood and a right ovarian cystectomy at 24 years of age. Her obstetrical history began with a full-term spontaneous vaginal delivery followed by conization because of cervical cancer at 28 years of age. Her second pregnancy ended in a missed abortion at 7 weeks' gestation with dilation and curettage treatment. In her previous pregnancy at 30 years of age, she received a historyindicated Shirodkar cerclage at 15 weeks' gestation. The cerclage was removed electively at 36 weeks' gestation. Six days after the release, she was admitted for unexpected massive bleeding because of cervical laceration at the 9 o'clock position before labor, and an emergency transverse cesarean delivery was performed under a diagnosis of abruption. Fourteen months after the cesarean section, she became pregnant again.On admission, her general condition was quite stable. Her vital signs were as follows: pulse, 80 bpm; blood pressure, 108/70 mm Hg; and body temperature, 36.6°C. On abdominal examination, she reported pain in the entire abdomen; the pain was strongest around the right hypochondriac region with rebound tenderness. Bowel sounds were audible but weak. Pelvic examination showed normal secretions, no Keywords ► uterine rupture ► Shirodkar cerclage ► cesarean ► conization ► second trimester Abstract A pregnant woman presented with acute upper abdominal pain and nausea at 15 weeks' gestation. She had a history of cesarean delivery for abruption after the removal of a Shirodkar cerclage that was placed because of cervical shortening caused by conization. She became pregnant again 14 months later. Ultrasonography revealed no significant findings, and a single intrauterine pregnancy with positive fetal heart activity was confirmed. An intestinal obstruction was suspected because abdominal radiography showed multiple air-fluid levels in the colon. Over the 3 hours following admission, her symptoms gradually worsened, and plain abdominal computed tomography (CT) showed a large hemorrhage in the abdominal cavity, but the uterine wall appeared intact at this time. Subsequently, dynamic CT revealed discontinuity of the uterine muscle layer. During laparotomy, uterine rupture with complete opening of the uterine wall at the site of the previous transverse scar was identified. A dead fetus was located within the amniotic sac in a blood-filled abdominal cavity. She received a total of 10 units of packed red blood cells and 6 units of fresh frozen plasma for the resuscitation. She was discharged on the eighth postoperative day without any complications.