[Uterine rupture during induced abortion with prostaglandins in the second trimester]

Based on our own experiences and on the literature of the past 14 years the variety of the presenting symptoms in patients suffering from ruptured uterus during the second trimenon are discussed. focussing especially on the first symptoms of a so-called "silent" uterus rupture. A 41-year old second gravida, first para--the healthy full-term child was delivered by Caesarean section--suffered a "silent" uterus rupture after termination of pregnancy at 20th/21st weeks' gestation. As more than 50 per cent of patients with "silent" uterus rupture are diagnosed with considerable delay, early and repeated ultrasound examinations should be performed in all patients with unexplained symptoms or if despite abortion induction for several days no progression of birth occurs. In an artificially induced abortion, prostaglandins should be topically applied to enhance cervix ripening, preferably as a biphasic treatment (first for cervix ripening, later induction of contractions). It is not yet clear whether a single or total dose reduction of prostaglandins used in labour induction in the second trimenon may help to prevent uterus rupture in patients at risk. Predisposing risk factors must be taken into account before applying prostaglandins. Uterus rupture should always be considered as differential diagnosis if problems occur in patients after induced abortion in the second trimenon.