A Rare Case: Spontaneous Uterine Rupture in First Pregnancy

Abstract

Introduction: Spontaneous uterine rupture is potentially catastrophic for both the mother and fetus. It is associated with risk factors, such as uterine abnormalities, uterine scar, macrosomic fetus, cephalopelvic disproportion, and use of uterotonic agents for induction of labor. We present a case of spontaneous rupture of an unscarred primigravid uterus, which is extremely rare. Case Report: A 22-year-old primigravida at 22 weeks presented to the emergency department with complaints of syncope and mild dyspnea. On her physical examination, she had a Glasgow coma scale of 15, tension arterial of 60/30 mmHg, and pulse rate of 110 beats/minute. Her first abdominal ultrasound was reported as normal. After consultation, the obstetrician reported that the fetus had normal fetal heart rate, and there had been no abnormality with the patient’s pregnancy. After intravenous infusion of 1000 ml saline, her hypotension still proceeded, and her second USG revealed free fluid in the abdomen. An emergency laparotomy was performed for a probable diagnosis of intra-abdominal hemorrhage and the fetus found floating freely in the peritoneal cavity. The patient recovered and discharged healthy 5 days after the operation, while the fetus could not survive. Conclusion: Although it is extremely rare in primigravidas, an emergency physician should consider spontaneous uterine rupture in pregnant patients with hemodynamic instability.