Spontaneous uterine rupture in a term pregnancy presenting with hemodynamic stability: a case report

Abstract

Spontaneous uterine rupture is a rare but life-threatening obstetric emergency, particularly in women without prior labor or trauma but with a history of uterine surgery such as myomectomy. It is even more uncommon in primigravida women presenting with hemodynamic stability, making early diagnosis and management critical. We report the case of a 32-year-old G1P0 woman at term with a past history of open myomectomy performed three years prior. She presented with a two-week history of intermittent sharp left flank pain associated with nausea and an urge to have bowel movement. Despite being hemodynamically stable (BP 128/79 mmHg, pulse 73 bpm), clinical suspicion warranted further investigation. Obstetric ultrasound revealed uterine rupture with intrauterine fetal demise. Emergency exploratory laparotomy was performed under spinal anesthesia. Intraoperative findings revealed a complete fundal uterine rupture with the fetal trunk and lower extremities covered in amniotic membranes freely lying in the peritoneal cavity along with 200 ml of amniotic fluid. The fetal head remained trapped in a uterus contracted to approximately 22 weeks’ size. There was no hemoperitoneum or blood clots. A lower uterine segment incision was made to facilitate extraction; however, full delivery was not possible. To prevent further uterine injury, fetal decapitation was performed. The uterus was subsequently repaired in layers at both the fundal rupture site and the lower uterine incision. Hysterectomy was avoided. The patient and her spouse were later counseled on the high risk of recurrence with future pregnancies and advised against conception, exploring alternative options for parenthood and contraceptive use. This case emphasizes the need for a high index of suspicion for uterine rupture in pregnant women with a prior history of uterine surgery, regardless of parity or hemodynamic presentation. Prompt diagnosis, surgical intervention, and tailored postoperative counseling are crucial in preserving maternal health and guiding future reproductive decisions.