Suspected illegal abortion and the use of misoprostol leading to the silent uterine rupture: A case report

Abstract

Uterine rupture is an uncommon, serious, and potentially life-threatening complication characterized as a disruption of the whole uterine muscle and the visceral peritoneum. Herein, we report a case of silent uterine rupture following illegal abortion via misoprostol administration. A 28-year-old female Gravida 2 Parity 1 living 1 at 18 weeks of gestation with a history of previous cesarean section presented to the hospital. She took 1000 µg of misoprostol tablet 1 day prior to her admission and due to unsuccessful abortion, presented to the hospital. The evidence of uterine perforation was not identified in the ultrasonography investigation. Following several attempts for abortion using misoprostol, oxytocin, trans-cervical Foley catheter, and dilation and evacuation (D & E) procedure, patients underwent exploratory laparotomy. Uterine rupture was diagnosed during surgery. The uterus was torn, and the fetus and placenta were found in the abdominal cavity with omentum sealing the rupture of the uterus. The fetus and placenta were removed and after proper toileting and controlling of bleeding, the uterus was closed. This case highlights the need for high-quality obstetric care and skilled paramedical and medical staff. It warns that medications such as prostaglandins and oxytocin should be administered only by experts and, lastly, that health facilities should not manage deliveries if they are not equipped well for the complications of delivery and labor. Our case also highlighted the possibility of silent uterine rupture in which the diagnosis is even harder. As a result, in cases where abortion approaches are unsuccessful, health practitioners should think about the possibility of uterine rupture.