Rupture of Unscarred Uterus: A Rare Cause of Abdominal Pain in Pregnancy

Abstract

Copyright: © 2015 Abdalla N, et al. This is an open‐access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Uterine rupture is rare during pregnancy and its associated with high maternal and fetal mortality [1]. The incidence rate of uterine rupture is 5,3 per 10000 deliveries among unselected pregnant women [2]. The most common risk factor of uterine rupture is previous caesarean section and uterine surgery [3]. Other risk factors include multiparity, a short length of time (less than 18 months) since the last caesarean section, the number of previous caesarean sections, single-layer closure instead of two-layer closure, placenta previa, fetal malpresentation, macrosomia, forced amnio-infusion, multiple gestation, cephalopelvic disproportion and the use of prostaglandins or oxytocin for labor induction [4,5]. In more than half of cases of ruptured unscarred uterus no evident risk factor can be found [1]. Rupture of unscarred uterus is very rare, involving 1: 17,000–20,000 deliveries, however it’s associated with high rate of maternal and perinatal morbidity and mortality [6,3]. The rupture could be traumatic or spontaneous [6]. The distribution of causes of uterine rupture varies from one country to another. In developed countries most uterine ruptures are associated with scarred uterus or trauma. In developing countries rupture occur mainly spontaneously in an unscarred uterus [7]. This may be related to multiparity in developing countries that causes weakening of the uterine wall. In the study of Schrinsky et al. 32% of women who had unscarred uterine rupture had a parity of greater than four [8].