Ruptured uterus: a rare and catastrophic complication of molar pregnancy

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 the gestational trophoblastic tumor include vaginal bleeding, uterine enlargement greater than expected for gestational age, hyperemesis, and secondary clinical hyperthyroidism. Less common presentations include pregnancy-induced hypertension in the first or second trimester of pregnancy and theca lutea cyst torsion. It is a rare incident to find uterine rupture because of a molar pregnancy. Most uterine ruptures reported so far were all malignant histologic types of the spectrum. This study presents a case of a ruptured uterus as a complication of complete molar pregnancy presenting with shock and severe anemia.

A 37-year-old gravida 6, para 5 patient with a 5-month amenorrhea presented to the hospital with vaginal bleeding, abdominal pain, and symptoms of anemia. The patient's hemoglobin level was 2.8 g/dL. Further assessment revealed a honeycomb-appearing endometrial mass and free fluid in the general peritoneum. The patient underwent emergency laparotomy, where a hysterectomy was performed for cornual uterine rupture. The patient was tested for serial serum human chorionic gonadotropin and declared cured after 6 months of observation.

Although rupture of the uterus 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 by serial serum human chorionic gonadotropin (HCG) safely for any transformation to gestational trophoblastic neoplasia (GTN).