Subtle presentation of complete uterine rupture in a scarred uterus: a case report

Uterine rupture is a rare but serious obstetric complication, most often associated with a scarred uterus following cesarean delivery. Although uterine rupture classically presents with acute abdominal pain, vaginal bleeding, and fetal distress, atypical manifestations may delay recognition and heighten maternal and fetal risk.

We report a 25-year-old gravida 2 para 1 woman with a prior lower-segment cesarean section who presented with a 14-hour history of vague abdominal discomfort and minimal vaginal bleeding, accompanied by cessation of fetal movements. Ultrasonography demonstrated placental remnants within the uterus and a deceased fetus in the abdominal cavity, consistent with complete uterine rupture. Hemodynamic and laboratory parameters remained stable. Emergency laparotomy confirmed rupture of the previous cesarean scar with extrusion of the fetus and placenta. The uterine defect was repaired, and the patient recovered uneventfully.

Uterine rupture may present with atypical findings such as mild abdominal pain or scant bleeding, which can complicate diagnosis. Evaluation should consider differential diagnoses including placenta previa, placental abruption, or spontaneous abortion. Ultrasonography can reveal uterine wall disruption, free intraperitoneal fluid, or extrauterine fetal parts, thereby aiding confirmation in stable patients. Prompt laparotomy with uterine repair or hysterectomy remains the cornerstone of management, underscoring the need for vigilance even in hemodynamically stable presentations.

This case underscores the diagnostic challenges of uterine rupture in hemodynamically stable patients with atypical symptoms and highlights the importance of maintaining a high index of suspicion while ensuring timely surgical intervention to mitigate maternal morbidity and mortality.