Uterine rupture in the first trimester: a case report and review of the literature

Abstract

Background Uterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, which is mostly due to catastrophic bleeding. First trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding such as an ectopic pregnancy. We present a case of first trimester scar dehiscence and conduct a literature review of this rare condition. Case presentation A 39-year-old African patient with four previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. She had two previous histories of third trimester uterine rupture in previous pregnancies with subsequent hysterotomies and repair. She underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently done. Conclusion In conclusion, the case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The risk factors, clinical presentation, diagnostic imaging, and management outlined may help in early identification and management of this rare but life threatening condition.

A cesarean section scar dehiscence during the first trimester of an intrauterine pregnancy: a rare case report and literature review

“…Delays in diagnosis can result in fatalities and severe bleeding. Therefore, it’s crucial to have a high index of suspicion, especially when there’s intense stomach discomfort and abnormal vital signs [ 3 ]. Particularly the same as our patient, who suffered from lower abdominal pain with a good general health condition that deteriorated several hours later.…”

“…The incidence of rupture in women with a previous cesarean section scar is 0.3% in comparison with an unscarred uterus, which is 1 in 5700 to 1 in 20 000 [ 3 ].…”

“…Patients with a prior cesarean section were more likely to develop uterine rupture when trying a vaginal birth [ 3 ]. Short interpregnancy intervals, classical uterine scars, and misoprostol treatment can also raise the chance [ 3 ].…”

“…However, uterine rupture can occur in women with scarring from myomectomy, profound corneal resection, corneal pregnancy, trauma, and previous cesarean sections [ 3 ].…”

“…When uterine rupture manifests clinically, it usually involves acute severe abdominal pain and vaginal bleeding. Hemodynamic instability accompanied by tachycardia and hypotension may also be present in the patient [ 3 ].…”