Uterine Rupture in Early Pregnancy

Abstract

Introduction Here, we present a case of uterine rupture in early pregnancy. The patient was known to have a unicornuate uterus and had suffered a previous uterine rupture resulting in an intrauterine death at 26 weeks of gestation. Background Uterine rupture in early pregnancy is rare but with potentially catastrophic complications. It is a recognised complication of pregnancy with a uterine abnormality such as unicornuate uterus. There are limited case reports of first-trimester uterine rupture, but a literature review shows that most firsttrimester uterine rupture cases were related to placenta percreta, previous uterine surgery, multiparity, or medical termination. Case report Our case describes a woman who was pregnant with her second pregnancy. She had a previous pregnancy where she had been found to have a unicornuate uterus and a preterm labour at 26 weeks complicated by a uterine rupture. At emergency laparotomy, it was found that the baby had been expelled through a posterior uterine wall tear. The tear was repaired with three layers. In her second pregnancy, she had undergone early pregnancy scans at a tertiary hospital in view of her history. These had confirmed a viable intrauterine pregnancy with no concerning features. The patient presented to our hospital at 11 weeks of gestation with sudden-onset severe abdominal pain but no vaginal bleeding. An initial transabdominal scan showed an intrauterine pregnancy and no apparent intra-abdominal free fluid. She was admitted for observations. Four hours later, she developed worsening abdominal pain with associated shoulder tip pain and a fall in haemoglobin. She underwent a transvaginal scan which showed a myometrial defect posteriorly with an apparent herniation of the sac, and free fluid was now noted. She was taken to theatre for an emergency laparoscopy. She was found to have significant haemoperitoneum and a 2 cm posterior wall tear. We performed a suction evacuation transcervically to remove the sac, and then, the tear was repaired with a single layer. The patient received a blood transfusion and was discharged well. Discussion Uterine rupture in early pregnancy is fortunately rare but can be life-threatening due to massive haemorrhage. The diagnosis should be considered in a pregnant patient of any gestation who is haemodynamically unstable with no overt bleeding, especially when risk factors such as prior history of uterine scar or uterine abnormality are present. Patients with significant risk factors should be counselled carefully regarding this.