Spontaneous Mid-Gestational Uterine Rupture in a Non-Scarred Uterus

A rare case of a late-diagnosed life-threatening second-trimester uterine rupture in a 26-year-old nulliparous woman (G2P0) with a non-scarred uterus at 20+4 weeks of gestation. Her history was significant for a spontaneous abortion, 17 months prior, managed by instrumental curettage. Initially managed as threatened miscarriage over 10 days, the patient was transferred in Stage IV hypovolemic shock. Ultrasound and diagnostic abdominal paracentesis revealed a massive hemoperitoneum and a non-viable fetus in the peritoneal cavity. An emergency laparotomy identified an anterofundal arcuate rupture on a suspected fundal placenta percreta spectrum. We performed a subtotal hemostatic hysterectomy. Five episodes of cardiac arrest complicated the procedure. Following intensive resuscitation and transfusions, the patient stabilized and was later discharged in good condition. Prior curettage was the plausible cause of focal decidual defects, facilitating deep trophoblastic invasion with a placenta percreta spectrum. High index of suspicion for an eventual mid-gestation spontaneous uterine rupture must be considered in patients with prior instrumentation history.