Spontaneous second trimester uterine rupture after classical cesarean

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Complications

Background:

• Spontaneous uterine rupture is a rare but serious obstetric emergency.
• Classical cesarean incisions are associated with a higher risk of uterine rupture compared to other cesarean types.
• Placenta percreta, an abnormal placental invasion, can further complicate pregnancy and increase rupture risk.

Observation:

• A 23-year-old woman presented at 15 3/7 weeks gestation with severe abdominal pain, hypotension, and tachycardia.
• She had a history of a classical cesarean section.
• Clinical examination revealed abdominal rebound and distention, suggestive of an acute abdominal event.

Findings:

• Exploratory laparotomy revealed a large spontaneous uterine rupture.
• The rupture occurred unusually early in the second trimester (15 weeks gestation).
• The patient underwent a hysterectomy due to the severity of the rupture.

Implications:

• This case demonstrates that spontaneous uterine rupture can occur as early as 15 weeks gestation after a classical cesarean.
• Severe abdominal pain in the early second trimester, especially in women with prior cesarean sections, warrants consideration of uterine rupture.
• Early recognition and surgical intervention are critical for managing uterine rupture and ensuring maternal safety.