A catastrophic posterior wall rupture in a non-scarred uterus: a life-saving obstetric hysterectomy

Abstract

Uterine rupture is a rare but life-threatening obstetric emergency associated with significant maternal and perinatal morbidity and mortality. Although uterine rupture is more common in women with a previous uterine scar, it can also occur in an unscarred uterus and is often unpredictable. This report aims to highlight the clinical presentation, management, and outcome of such a case. We describe a case of a 32 year old multiparous woman at 40 weeks and 3 days of gestation who was referred in a state of shock following a prolonged trial of labor. Clinical examination and intraoperative findings confirmed uterine rupture with intrauterine fetal demise. Emergency laparotomy was performed after initial resuscitation. Intraoperative findings revealed approximately 2 liters of hemoperitoneum and a complete rupture of the posterior wall of uterus vertically extending into the cervix and laterally extending to left pelvic wall, with the fetus lying in the peritoneal cavity. A total obstetric hysterectomy with left salpingo-oophorectomy was performed due to extensive rupture. The patient received blood transfusion and intensive postoperative care, resulting in gradual recovery and stabilization. Rupture of an unscarred uterus, though rare, can lead to catastrophic outcomes if not recognized promptly. Early diagnosis, timely referral, aggressive resuscitation, and prompt surgical intervention are critical for maternal survival. Strengthening intrapartum monitoring and ensuring appropriate labor management can help prevent such complications.