Authors: Sandeep Kaur, Tharani Yogeswara, Ahmar Shah.
Background: Rupture of an unscarred uterus is a rare catastrophic event, with the incidence being reported in literature as 1/16,840 deliveries to 1/19,765 deliveries in the developed world. Due to the rarity of their occurrence, the diagnosis may be delayed and thus resulting in serious maternal and fetal complications. The risk of rupture recurring in a future pregnancy can range from 6% to 32 % (Lower segment v/s upper segment rupture). Therefore these women are advised to give birth by repeat caesarean section prior to onset of labour.
Case: A 26 years old primigravida presented at 36+3 weeks with sudden onset of severe abdominal pain. A working diagnosis of concealed abruption was made in view of her symptoms and a non-reassuring fetal trace. Exploratory laparotomy was performed and a complete posterior wall rupture was noted, which was repaired with favourable outcome. Four years later the patient conceived again and had a planned caesarean delivery at 34 weeks.
Discussion: A nulliparous uterus is often described as “virtually immune to rupture” especially before the onset of contractions. Isolated case reports of rupture in primi gravida women have been reported in association with connective tissue diseases such as Ehlers-Danlos syndrome, chronic steroid use, inutero exposure to
diethylstilboestrol and cocaine misuse. Our lady did not have any of the underlying risk factors as mentioned above which could have triggered primary uterine rupture of the posterior wall.
Conclusion: We report the rare occurrence of a spontaneous uterine rupture in a non-labouring primigravida with no apparent risk factors, along with details regarding her subsequent pregnancy. As majority of such ruptures are being managed by conservative surgeries; therefore women contemplating a repeat pregnancy after a primary uterine rupture should be managed on an individualized basis.
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