Antepartal Spontaneous Complete Fundal Non-Scarred Uterine Rupture in Twin Pregnancy.

Abstract

A 31-year-old, otherwise healthy patient (G1/P0) had a history of left salpingectomy for ectopic (tubal) pregnancy followed by diagnostic laparoscopy and uterine septal incision. Because of primary infertility, she underwent assisted reproduction (in vitro fertilization/embryo transfer), which resulted in a bichorial-biamniotic twin pregnancy. The further course was uneventful until 36 weeks when she felt pain in the epigastrium, leading her to be admitted to the hospital under suspicion of epigastric hernia. On admission, cardiotocographic and ultrasound findings showed a normal state of pregnancy with a palpable mobile, painless epigastric formation, without contractions and other symptoms. Two days after admission, she developed sudden pain and acute abdomen without labor, so an urgent laparotomy for suspected uterine rupture was performed, revealing a complete (12 cm) fundal rupture ([Fig. 1]) with prolapsed amniotic sac and twin legs. Live eutrophic twins (2710 g/48 cm, Apgar 10/10; 2790 g/48 cm, Apgar 10/10) were delivered through Kerr’s transverse isthmic hysterotomy, the placenta was removed, and a primary two-layer uterine suture was performed. The postoperative course was complicated by febrile puerperium, which was resolved by antibiotic treatment with complete maternal recovery.