English

Abstract

OBJECTIVE: Presenting a case of uterine rupture as early as 20 weeks of gestation after classical caesarian section done with short inter pregnancy duration and inter delivery duration of 9 months. CASE: 26 years old women gravida 2, para 1, and Death 1 with 20 weeks gestation with history of classical c-section done 9 months back in rural area (Bihar) for IUFD (cause not known) presented to out-patient department with abdominal pain, uterine contraction & severe scar tenderness present. Patient was sent for USG and she followed up in OPD within an hour with the USG report showing single live intrauterine pregnancy of 19 weeks and 5 days and told that her pain had subsided. Suspecting a uterine rupture a repeat USG was done which showed a totally different picture suggesting 3.2 cm rupture in the anterior wall with protrusion of fetal parts, limb in the anterior pouch, with amniotic fluid surrounding it. FHS was present/ irregular. No liquor in uterine cavity, No Hemoperitoneum. Cervical length 2 cm. On Examination Uterus was relaxed. On Exploratory Laparotomy, Classical scar rupture was found and, fetus and placenta removed. Scar was sutured back and uterus preserved. CONCLUSION: Spontaneous uterine rupture after classical caesarian section and short inter delivery duration can occur as early as 19-20 weeks of gestation. Uterine rupture should be considered as one of the causes of severe abdominal pain in early second trimester.