Spontaneous Uterine Rupture during Pregnancy: Case Report and Review of Literature

Abstract

Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 34 weeks in a 35 year old patient. The case was managed at the University Teaching Hospital of Yaounde (Cameroon). She had past history of two uterine curettages. She presented with abdominal pain of sudden onset. After ultrasound scan, uterine rupture was diagnosed and an emergency laparotomy done. The entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Spontaneous uterine rupture occurs when there is an upper segment uterine scar. This case report shows that past history of curettage is a risk factor for the presence of uterine scar. RÉSUMÉRupture spontanée de l'utérin pendant la grossesse: rapport du cas et bilan de la documentation La rupture d'un uterus gravid est une urgence chirurgicale. Les facteurs de prédisposition comprennent un utérin cicatriciel. La rupture spontannée d'un utérin non-cicatriciel pendant la grossesse est rare. Nous présentons ici un cas d'une rupture complète et spontanée de l'utérin à un âge gestationnel de 34 semaines chez une patiente de 35 ans. Le cas a été pris en charge au Centre Hospitalier Universitaire de Yaounde (Cameroun). Elle avait un antécédent de deux curettages de l'utérin. Lorsqu'elle s'était présentée pour la première fois, elle souffrait d'une douleur abdominale qui avait commencé soudain. Après avoir une échographie, nous avons diagnostiqué une rupture de l'utérin et une laparotomie d'urgence a été faite. La cavité amniotique entière se trouvait dans la cavité péritonéale avec une rupture du fond de l'utérus. La rupture spontanée de l'utérin se produit quand il y a une cicatrice du segment supérieur de l'utérin. Ce rapport de cas montre que les curettages comme antécédents constituent un facteur de risque quant à la présence de la cicatrice de l'utérin. (Rev Afr Santé Reprod 2007; 11[2]:98-103).

Non-Laboring Uterine Rupture of an Unscared Uterus before Term Discover during Obstetric Ultrasound

“…The incidence of uterine rupture on non-scarreduterus is very low in developed countries, around 1/20,000 deliveries, not exceeding 30% of all uterine rupture [6]. Factors predisposing to spontaneous ruptures on non-scarred uterus are: mechanical obstructed labor (20% -40% fetopelvic disproportion), large multiparity (4 children), short interval between pregnancies (<18 months), maternal age early or advanced, and a low socio-economic level, uncontrolled use of oxytocics, congenital uterine malformations such as pseudo unicorn uterus, placenta accreta or percreta placentation abnormalities [5] [6] [7]. Our patient was a large multiparous with 8 children and large multiparity is generally recognized as one of the etiological factors associated with a high risk of uterine rupture on a healthy uterus [8], which acts by altering the uterine wall, which becomes weakened.…”

“…The vital prognosis of the mother and the child is most often committed when the uterine rupture occurs on an unscarred uterus [5]. Uterine rupture in a woman with an unscarred uterus, outside of labor and before term is an exceedingly rare event.…”

Spontaneous Rupture of Unscarred Gravid Uterus

“…Factors that can predispose to uterine rupture are multiparity, advanced maternal age, scarred uterus, big fetus, obstetrical maneuvers like external cephalic or internal podalic version, instrumental deliveries, etc. Uterine rupture can also occur in the absence of these factors (2). Although there are several known factors that increase the risk of uterine rupture, the overall incidence of uterine rupture is low even in high‐risk subgroups.…”

“…This obstetrical emergency is almost always associated with high maternal and fetal mortality and morbidity (1). The Uterus ruptures usually during delivery, although it can also occur during pregnancy (2). Overall incidence of rupture of uterus during pregnancy is 0.07%.…”

Rupture of uterine muscle hematoma following diagnostic amniocentesis at 18 weeks and uterine dehiscence at term

“…4 Factors that can predispose to uterine rupture are multiparity, advanced maternal age, a scarred uterus, a big foetus, mal presentation, and others. 5 Uterine dehiscence / incomplete uterine rupture / silent rupture is classically defined as a disruption of the uterine musculature, without extravasation of the intraamniotic contents and foetal parts into the peritoneal cavity, and with intact serosa. 4 In most cases it is asymptomatic.…”