Uterine Rupture in Early Pregnancy

Submit Manuscript | http://medcraveonline.com the rupture of an unscarred uterus a very rare event (about 1 in 15 000) [2,3]. The incidence of rupture in scarred uteri has been increasing in the last few years, probably reflecting the increasing cesarean section rates in most resource-rich countries, which now exceed 20% [4,5]. The overall incidence of uterine rupture in women with a previous cesarean section varies between 0.3 to 1 percent [6]. Almost all uterine ruptures in developed countries occur in the third trimester of pregnancy, near term and, mainly, in the setting of trial of labor after cesarean delivery (TOLAC) [7]. Poor Bishop score on admission to labor, labor induction with prostaglandins (mainly misoprostol) and labor dystocia have been stablished as important risk factors that affect the incidence of uterine rupture during TOLAC [7]. Advanced maternal and gestational age, high parity, macrossomia, short inter-delivery interval (<18 to 24 months) and single-layer uterine closure were also associated with increased risk for uterine rupture.6 For this last risk factor, there are some conflicting results [8]. First and second trimester uterine ruptures are very unusual [9,10]. The first report of a spontaneous early pregnancy scar rupture was published in 1982 in Denmark [11]. Although early uterine rupture is associated with high maternal and fetal morbidity and mortality, there are few case reports of conservative managment of the uterine defect with successful outcome [4,12]. Clinical signs of uterine rupture in early pregnancy must be distinguished from other acute abdominal and obstetric emergencies. The most relevant differential diagnosis is ectopic pregnancy, although bleeding from corpus luteum, miscarriage, heterotropic pregnancy and molar pregnancy with secondary invasion can be considered [4,9]. Abdominal pain, vaginal bleeding and vomiting are common findings in uterine rupture and emergent surgical intervention is generally needed since intraabdominal hemorrhage can lead to progressive maternal hemodynamic deterioration [9]. Generally, the uterine defect occurs in the previous incision and it is closed like a traditional hysterotomy closure with additional interventions, as needed, to ensure hemostasis. If that is not possible, a hysterectomy may be performed [5]. Considering its rarity, here we report a case of an early pregnancy uterine rupture.