Unexpected Rupture of Unscarred Uterus at 12 Weeks of Pregnancy: A Case Report and Literature Review

Abstract

IntroductionUterine rupture is an unusual but serious event in pregnancy. Most cases of uterine rupture occur in the second and third trimesters in the scarred uterus (such as previous caesarean section, hysterotomy or myomectomy) (1). The unscarred uterine rupture is an infrequent condition predisposed by multiparity, malpresentation, use of uterotonic drugs (such as oxytocin or prostaglandins), and connective tissue diseases (2). There are some reports regarding uterine rupture in the absence of labor, without any risk factors (3-9). The chief predisposing factor for unscarred uterine rupture is multiparity (3). On the other hand, unscarred uterine rupture in the absence of labor in the first trimester of pregnancy is a very rare phenomenon on which 3 cases were reported (10-12).In this paper, a very rare case of unscarred uterine rupture in the first trimester in the absence of labor is presented where multiparity was the only risk factor. Case PresentationA 34 years old female with a history of vaginal delivery, gravida 2, para 1, and gestational age of 12-13 weeks referred to the emergency room of Tabriz Taleghani hospital. Her chief complain was abdominal pain. She was alert and oriented. She had no fever, chills, nausea, vomiting, vaginal bleeding or signs of delivery. She had no history of surgery, curettage, and abortion. Past medical history was negative. On physical examination, vital signs were stable. Abdominal examination revealed mild tenderness in the right lower quadrant, and cervix was normal and closed in gynecological examination. In laboratory tests, Hb was 10.6 mg/dL The patient was hospitalized and observed. Ultrasound was performed due to persistence and exacerbation of abdominal pain, and showed the intrauterine gestational sac with a live fetus of 12 weeks and 3 days. The amniotic fluid and adnexa were normal, and a lot of free liquid was seen in abdomen and pelvis which was infiltrated into the splenorenal and Morrison's space. Given the possibility of hemoperitoneum, she underwent urgent laparotomy through a midline incision, and there was about 2 L of blood in the abdomen and pelvis. A rupture of about 5 cm was found on the posterior wall of the uterus. Placenta and fetus with intact sac were bulging into the abdomen from the rupture site. There was an active bleeding from uterine rupture. Fetus and placenta were removed completely and the rupture was repaired in three layers of endometrium, myometrium, and perimetrium. The patient received two units of isogroup packed red blood cells and she was discharged on the third day (Figures 1 and 2). AbstractObjectives: Uterine rupture is an infrequent but serious event in pregnancy, which happens commonly in the second and third trimesters in scarred uteruses and labor phases. Uterine rupture during labor is very rare in the absence of scar and occurs mainly in multiparous women. This article introduces a very unusual case of unexpected rupture of an unscarred uterus in the 12th week of gestation. Case Presentation: A 34 year old woman with...

First Trimester Uterine Rupture: A Case Report and Literature Review

“…Of this group, most cases had a uterine anomaly (10/23, 43.48%), 3 had a PAS disorder (3/23, 13.04%), 2 had an ART-induced pregnancy (2/23, 8.70%), 2 had a pharmacological termination of pregnancy (2/23, 8.70%), 3 others were multiparous (three or more previous births) (3/23, 13.04%) [9,16,26] (Table 1, Table 2, and Supplementary Tables S3-S5). However, in 4 cases, no clearly recognizable predisposing factor was present (4/19, 21.05%) [8,12,55,77].…”

First trimester uterine rupture-a rare but catastrophic event: a case report

“…1,7 In a case series by Vaezi et al, 8 cases of uterine rupture were reported in unscarred uterus at a gestational age below 20 weeks. 8 In all those cases, the fundus was the rupture site. Multiparity was suggested as the main predisposing factor in most cases.…”

Life-Threatening Obstetrical Emergency: Spontaneous Uterine Rupture Associated with Placenta Percreta in the First Trimester of Pregnancy—Case Report and Literature Review

“…Placenta percreta was observed only in two cases. The defect was repaired in half of the cases [37].…”