Repair of uterine rupture in twin gestation after laparoscopic cornual resection

Spontaneous uterine rupture in the course of pregnancy is a rare event that usually occurs in a scarred uterus. The event occurs mostly during the intrapartum period and is potentially catastrophic for both mother and fetus. We report a case of 2-cm cornual rupture in a pregnant woman at 13 weeks twin gestation with previous history of cornual pregnancy successfully managed via laparoscopy. Sudden onset of abdominal pain and vaginal bleeding was noted first. Physical examination revealed stable vital signs, lower abdominal tenderness, and mild rebounding pain. Pelvic ultrasonography revealed twin pregnancy at 13 weeks with extrauterine saccular structure 6 cm in diameter located on the left fundus and contiguous with an intrauterine oligohydramnics twin. Exploratory laparotomy was promptly performed, and a small rupture about 2 cm in diameter was observed on the upper portion of the left fundus, the site of a previous laparoscopic cornual resection scar. A protruding amniotic sac of about 6 cm diameter and containing some part of the umbilical cord was seen. The uterine rupture site was repaired directly after aspiration of amniotic fluid from the protruding sac. After surgery, the patient received antibiotics, 17-OH-progesterone for potential rupture of membranes and prematurity. Tocolysis with Ritodrine for irregular uterine contractions was given at 22 weeks gestation. Steroids were given at 24 weeks gestation. The pregnancy ended with a successful delivery by cesarean section because of uncontrollable uterine contractions at 30 5/7 weeks gestation. In conclusion, although termination of pregnancy would normally be recommended when uterine rupture occurs, a different approach to management may now be accepted.