Spontaneous uterine rupture as a life-threatening presentation of molar pregnancy: a case report

Gestational trophoblastic disease is the term used to describe the heterogeneous group of interrelated lesions that arise from abnormal proliferation of placental trophoblasts. The clinical presentations of gestational trophoblastic tumor are vaginal bleeding, uterine enlargement greater than expected for gestational dates, hyperemesis, secondary clinical hyperthyroidism, and less common presentations such as pregnancy-induced hypertension in the first or second trimester and theca lutea cyst torsion. It is a rare incident to find uterine rupture due to a molar pregnancy. Most uterine ruptures reported so far were all malignant histologic types of the spectrum.

We present a case of ruptured uterus as a complication of complete molar pregnancy presenting with shock and severe anemia. A 37-year-old Ethiopian gravida 6 para 5 with 5-month amenorrhea came with vaginal bleeding, abdominal pain, and symptoms of anemia. Her hemoglobin was 2.8 g/dl, and there was a honeycomb-appearing endometrial mass and free fluid in the general peritoneum. She underwent emergency laparotomy, where a hysterectomy was done for cornual uterine rupture. She was followed with serial serum human chorionic gonadotropin and declared cured after 6 months of surveillance.

Even though it is rare, a ruptured uterus in a molar pregnancy can be a catastrophic complication, presenting with massive hemoperitoneum and hemorrhagic shock. Hysterectomy, along with vascular filling with crystalloid and transfusion of blood products, can save a patient's life. Patients can be followed with serial serum human chorionic gonadotropin for any transformation to gestational trophoblastic neoplasia.