Non-hemorrhagic uterine rupture at 28 weeks of pregnancy fol
There is a need to put forward more symptoms and signs that could suggest a diagnosis of uterine rupture so that clinicians’ suspicion is increased; there is also a need to put forward uncommon intraoperative findings in patients with uterine rupture to correlate with the signs and symptoms of patients.

A 33-year-old Gravida 5 Para 4+0 with 2 previous cesarean section scars at 28 weeks of amenorrhoea, presented to the hospital complaining of lower abdominal pain for 11 h. She had no vaginal bleeding or vaginal discharge or pain on passing urine.

On examination she had no pallor, pulse rate was 84 bpm, blood pressure was 110/80 mm of mercury (mmHg), fundal height was 27 cm (cm), fetal heart rate was regular at 150 beats per minute (bpm) and her cervix had a parous os. She was diagnosed with preterm labor and given dexamethasone intramuscularly, then an obstetric ultrasound scan was done and it revealed severe oligohydramnios.

The decision to deliver her by emergency cesarean section was made and intraoperative findings were of a uterine rupture along the uterine scar with a fetal arm protruding through a vernix caseosa in the peritoneal cavity, without active uterine bleeding. The patient recovered well postoperatively.

There is a need to suspect uterine rupture in pregnant women with previous cesarean section scars if they present with abdominal pain and are found to have severe oligohydramnios despite having no history of any vaginal discharge, even when the fetal heart rate is normal and they are hemodynamically stable and without vaginal bleeding and remote from term.

BMC Pregnancy and Childbirth
Source: BMC Pregnancy and Childbirth