Abstract
The aim is to report a case of spontaneous uterine rupture in the first trimester of pregnancy and to review the literature on the topic. Methods: A literature search was performed using PubMed and Scopus. Relevant English articles were identified without any time or study limitations. The data were aggregated, and a summary statistic was calculated. Results: A 35-year-old gravida 5, para 2 was admitted at our department because of fainting and abdominal pain. The woman had a first-trimester twin pregnancy and a history of two previous cesarean sections (CSs). Suspecting a uterine rupture, an emergency laparotomy was performed. The two sacs were completely removed, and the uterine rupture site was closed with a double-layer suture. The patient was discharged from hospital four days later in good condition. On the basis of this experience, a total of 76 case reports were extracted from PubMed and included in the review. Fifty-three patients out of 76 (69.74%) underwent previous surgery on the uterus. Most women (67.92%) had a CS, and in this group a cesarean scar pregnancy (CSP) or a placenta accreta spectrum (PAS) disorder was found to be the etiology in 77.78% of cases. Furthermore, 35.85% of the women had hysterectomy after uterine rupture. Twenty-three patients out of 76 (30.26%) had an unscarred uterus. Of this group, most women presented a uterine anomaly (43.48%). Moreover, 17.39% of these women had a hysterectomy. Conclusion: According to the literature, the current pandemic use of CS explains most cases of first-trimester uterine rupture.
Highlights
Rupture of the uterus is a rare, serious, and potentially fatal complication of pregnancy
It demonstrates that most first-trimester uterine ruptures occur in a scarred uterus (69.74%), and the top three surgical interventions associated for the uterine wall disruption are cesarean section
First-trimester uterine rupture may happen in unscarred uteri as well
Summary
Rupture of the uterus is a rare, serious, and potentially fatal complication of pregnancy. A uterine rupture is defined as a disruption of the whole uterine muscle and the visceral peritoneum. This term is often confused with uterine dehiscence, in which the integrity of the visceral peritoneum is retained [1]. Most uterine ruptures occur at the term of pregnancy and only a limited number of cases occur in the first or second trimester of pregnancy [2]. There are cases of uterine rupture where the cause remains unknown. Our aim is to review the literature after having presented a case report of spontaneous uterine rupture in the first trimester of pregnancy. The specific objectives of the systematic review expressed in terms of population, exposure, and outcome are reported in Supplementary
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