Spontaneous Uterine Artery Rupture in Pregnancy, With Subsequent Severe Foetal Intracranial Haemorrhage

Spontaneous rupture of the uterine artery during pregnancy is an exceptionally rare and life-threatening obstetric emergency. It often presents with sudden hemodynamic instability in the absence of external bleeding, posing diagnostic and management challenges. While maternal outcomes depend on timely intervention, foetal outcomes may be significantly affected by acute uteroplacental insufficiency. We report a case of a 23-year-old gravida 2 para 1+0 woman at 26 weeks of gestation who presented with sudden hypovolemic shock without external haemorrhage. A prior anomaly scan at 23 weeks was unremarkable. Emergency laparoscopic exploration revealed approximately 3L of hemoperitoneum due to a ruptured branch of the left uterine artery, which was successfully ligated. The patient received eight units of blood transfusion and required intensive care support for 5 days. Subsequent foetal follow-up revealed severe neurological sequelae. Ultrasound at 32 weeks demonstrated marked tetra-ventriculomegaly with features suggestive of intracranial haemorrhage. Repeat imaging at 35 weeks confirmed persistence of findings along with foetal growth restriction. The patient delivered at 38 weeks, and postnatal imaging confirmed hydrocephalus requiring ventriculoperitoneal shunt placement. This case highlights the rare occurrence of spontaneous uterine artery rupture and its significant foetal neurological consequences, emphasizing the importance of early recognition and vigilant foetal surveillance following maternal hypovolemic events.