Silent rupture of unscarred uterus at 32 weeks: Case reports

Abstract

Introduction: Rupture in an unscarred uterus prior to onset of labor in third trimester is a rare event and very few cases have been reported in literature so far. Case Report 1: We describe a case of a primigravida who presented in emergency with pain abdomen with placenta praevia and severe oligominos. An ultrasound was conducted which reported bicornuate unicollis uterus with single live foetus 33+4 weeks having severe oligohydromnios (AFI=2) with placenta anterior and reaching upto internal os in one cornua, the other cornua was empty. A MRI was conducted, which was also inconclusive. She was taken up for laprotomy, peroperatively pregnancy was present in left horn of uterus which had ruptured with intact amniotic sac and was covered with omentum, the placenta was covering the lower half of the left horn and the right horn looked like normal uterus and was empty. The omentum was carefully separated and baby that was delivered weighed 700gms. The left horn was excised and then uterus was closed in layers. Patient was followed up for 6 months, mother was doing well, though baby was 5 kg which was less than the weight for that age and had slow developmental milestones. Case Report 2: Our second case was a 30 years old gravida 5, para 2, abortion 2 woman with 8 months amenorrhea. She was referred with chief complaint of pain abdomen. On examination, she looked almost stable. Even though she was pale; vital signs were within normal parameters. An ultrasound was conducted which showed single live intrauterine foetus 29+2 weeks with absent liquor with placenta praevia with placenta acreta. Emergency laprotomy was decided in view of placenta acreta. It was found to be an abdominal pregnancy. Amnion along with omentum and blood clot matting sac like structure sitting over the fundus with placenta perforating the fundus small incision was given at the fundus and baby weighing 1.15 kg delivered through it. Placenta did not separate and so decision of hysterectomy taken.