EC Gynaecology

Spontaneous uterine rupture, particularly in the second trimester of gestation, is a rare but potentially catastrophic event. This is especially concerning when it occurs without typical signs such as abdominal pain or vaginal bleeding. We present a case of a silent uterine rupture at 28 weeks of gestation in a patient with a history of one previous lower segment cesarean section. The rupture led to the extrusion of an intact amniotic sac, and the delivery of a male neonate with an Apgar score of 8 and 9. Remarkably, both the mother and neonate experienced no immediate morbidity or mortality. This case highlights the importance of a high index of suspicion, thorough imaging, and early intervention in diagnosing silent uterine rupture. Such occurrences are extremely rare, and few cases have been documented in literature.

 Keywords: Spontaneous Uterine Rupture; Cesarean Section; Second Trimester; Silent Rupture; Uterine Dehiscence

1. Smith GC., et al. "Risk of uterine rupture in women with previous cesarean section”. Lancet 9262 (2021): 345-351.
2. Bujold E., et al. "Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment”. American Journal of Obstetrics and Gynecology 3 (2011): 320.e1-320.e6.
3. Grobman WA., et al. "Prediction of uterine rupture associated with attempted vaginal birth after Cesarean delivery”. American Journal of Obstetrics and Gynecology 1 (2008): 30.e1-30.e5.
4. Walsh CA and Baxi LV. "Rupture of the primigravid uterus: a review of the literature”. Obstetrical and Gynecological Survey 5 (2011): 327-354.
5. Esmans A., et al. "Placenta percreta causing rupture of an unscarred uterus at the end of the first trimester of pregnancy: case report”. Human Reproduction 10 (2014): 2401-2403.
6. Kieser KE and Baskett TF. "A 10-year population-based study of uterine rupture”. Obstetrics and Gynecology 4 (2012): 749-753.
7. Damiani GR., et al. "Uterine rupture in a nulliparous woman with septate uterus of the second trimester pregnancy”. International Journal of Surgery Case Reports 3 (2013): 259-261.
8. Imseis HM., et al. "Spontaneous rupture of a primigravid uterus secondary to placenta percreta”. Journal of Reproductive Medicine 3 (2008): 233-236.
9. Dow M., et al. "Third-trimester uterine rupture without previous cesarean: a case series and review of the literature”. American Journal of Perinatology 10 (2011): 739-744.
10. Grobman WA., et al. "Prediction of uterine rupture associated with attempted vaginal birth after Cesarean delivery”. American Journal of Obstetrics and Gynecology 1 (2008): 30.e1-30.e5.