Spontaneous Uterine Rupture in the Second Trimester:a Case Report

We report a case of spontaneous uterine rupture at 17+6 week’s gestation in a nulliparous 32 year old patient with no history of myometrial surgery. She had presented with lower abdominal discomfort, progressing to severe pain with hypotension and tachycardia. An urgent ultrasound pelvis showed a live fetus with fetal tachycardia, free intra-peritoneal fluid with blood clots and myometrial defects on the uterine fundus. An emergency laparotomy performed revealed 1.7 liters of hemoperitoneum, with the fetus intact in the amniotic sac free floating in the peritoneal cavity. The uterine fundal rupture was successfully repaired. Placenta histology revealed placenta accreta. This case report demonstrates that a high index of suspicion, rapid diagnosis aided by imaging modalities and immediate surgical intervention are crucial steps in successful management. A postulated etiology in our patient is that of an upper scar from a previous uterine curettage with abnormal placentation predisposing to spontaneous rupture.