Unusual Presentation Of Uterine Rupture In A Low Resource Setting: A Case Report And Review Of Literature
Keywords:
Cesarean section, Laparotomy, Uterine ruptureAbstract
Uterine rupture is an obstetric emergency that can be fatal. It is of public health importance in developing countries because of the high risk of maternal and fetal mortality associated with it. The incidence of uterine rupture is 1.3% in Africa. The rates of uterine rupture in Nigeria, range from 1 in 81 to 1 in 426 births. Despite it been a rare obstetric complication, the mortality rate is about 5%, and the fetal death rate exceeds 65%.A previous uterine scar is the most common risk factor for uterine rupture, especially following a previous cesarean delivery. Although it is uncommon, uterine rupture can sometimes occur without any noticeable symptom. Silent uterine rupture can be very difficult to identify, hence early clinical diagnosis and prompt surgical intervention is paramount to maternal fetal survival. This was a case of Mrs H E, a booked 29 year old G4P3+0(3A), with 1 previous cesarean section in 2023, registered her antenatal care in a primary health care centre. She presented for expert care in anticipation of delivery. At presentation, there were no classical symptoms of uterine rupture and her haemodynamic status was good. However, the fetal parts were easily palpable per abdomen with absent fetal tone. Emergency ultrasound (USG) scan done showed a 3kg foetus with its placenta in the amniotic sac outside the uterine cavity which was empty, with the conclusion of abdominal ectopic gestation. A silent uterine rupture was confirmed intraoperatively. She had laparotomy with uterine repair only and her post-op condition was satisfactory. It is extremely rare for the uterus to rupture silently before, more so with an intact amniotic sac outside the uterine cavity. Making this diagnosis requires a strong index of suspicion and accurate imaging throughout pregnancy.
References
1. Figueiró-Filho EA, Gomez JM, Farine D. Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study. Rev Bras Ginecol e Obstet. 2021;43(11):820–5.
2. Pontis A, Prasciolu C, Litta P, Angioni S. Uterine rupture in pregnancy: Two case reports and review of literature. Clin Exp Obstet Gynecol. 2016;43(2):305–9.
3. Flis W, Socha MW, Wartęga M, Cudnik R. Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions. J Clin Med. 2023;12(10).
4. Al-Zirqi I, Vangen S. Prelabour uterine rupture: characteristics and outcomes. BJOG An Int J Obstet Gynaecol. 2020;127(13):1637–44.
5. Abdulmane MM, Sheikhali OM, Alhowaidi RM, Qazi A, Ghazi K. Diagnosis and Management of Uterine Rupture in the Third Trimester of Pregnancy: A Case Series and Literature Review. Cureus. 2023;15(6):1–6.
6. Woo JY, Tate L, Roth S, Eke AC. Silent Spontaneous Uterine Rupture at 36 Weeks of Gestation. Case Rep Obstet Gynecol. 2015;2015:1–3.
7. Astatikie G, Limenih MA, Kebede M. Maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture. BMC Pregnancy Childbirth. 2017;17(1):1–9.
8. Eze JN, Anozie OB, Lawani OL, Ndukwe EO, Agwu UM, Obuna JA. Evaluation of obstetricians ’ surgical decision making in the management of uterine rupture. 2017;4–11.
9. Adegbola O, Odeseye A. Uterine rupture at Lagos University Teaching Hospital. J Clin Sci. 2017;14(1):13.
10. Rottenstreich M, Rotem R, Hirsch A, Farkash R, Rottenstreich A, Samueloff A, et al. Delayed diagnosis of intrapartum uterine rupture–maternal and neonatal consequences. J Matern Neonatal Med [Internet]. 2021;34(5):708–13. Available from: https://doi.org/10.1080/14767058.2019.1613366
11. Ekine A, Udoye P, West O. Determinants and Factors influencing the prevalence of uterine rupture in a tertiary rural hospital in the Niger Delta: A 5 years retrospective study in NDUTH, Okolobiri. Pharma Innov J TPI. 2015;4(42):97–101.
12. Woo JY, Tate L, Roth S, Eke AC, Presentation C. Case Report Silent Spontaneous Uterine Rupture at 36 Weeks of Gestation. 2015;2015:3–5.
13. Ukah CE, Okhionkpamwonyi O, Okoacha I, Okonta PI. A 5-year review of hysterectomy at the Delta State University Teaching Hospital, Oghara, south-south Nigeria. Ibom Med J. 2023;16(3):268–72.
14. Okhionkpamwonyi O, Okonta PI.Total abdominal hysterectomy at the Central Hospital, Warri:a fiveyear review. Borno Med Journal.2015;12(1):23-29.
15. Alemu AA, Bitew MS, Gelaw KA, Zeleke LB, Kassa GM. Prevalence and determinants of uterine rupture in Ethiopia: a systematic review and meta-analysis. Sci Rep [Internet]. 2020;10(1):1–11. Available from: https://doi.org/10.1038/s41598-020-74477-z
16. Motomura K, Ganchimeg T, Nagata C, Ota E, Vogel JP, Betran AP, et al. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health. Sci Rep. 2017;7(March):1–9.
17. Chen L, Li H, Peng J, Li M, Wang Y, Zhao K, et al. Silent uterine rupture in the term pregnancy: Three case reports. Med (United States). 2024;103(10):E37071.
18. Rajoria A, Mittal M, Aggarwal G. A Rare Case of Sonographically Detected Silent Rupture of a Gravid Uterus With Expulsion of a Complete Fetus and an Intact Amniotic Sac. 2025;17(8):1–5.
19. Langhe R, Shah UF, Alfathil A, Gannon M. Silent uterine rupture in scarred uterus. BMJ Case Rep. 2017;2017:2016–8.
20. Tinelli A, Kosmas IP, Tony J, Howard C, Malvasi A, Cohen SB, et al. Uterine rupture during pregnancy : The URIDA ( uterine rupture international data acquisition ) study. 2021;(April):1–9.
21. Omagbe O, Okhionkpamwonyi O, Akhator AE. Uptake of Long-acting Reversible Contraception at the Delta State University Teachinhg Hospital, Oghara, Nigeria: A Three Year Review. Afr J Health and Social Sci.2025;2(1):53-56
22. Okhionkpamwonyi O, Okonta PI, Okoacha I, Idogun S. Niric oxide in infertile female in the niger-delta region of Nigeria. Niger J Clin Pract. 2021;24(7):1022-1027.
23. Sayed Ahmed WA, Habash YH, Hamdy MA, Ghoneim HM. Rupture of the pregnant uterus - a 20-year review. J Matern Fetal Neonatal Med. 2017 Jun;30(12):1488-1493. doi: 10.1080/14767058.2016.1219997. Epub 2016 Aug 23. PMID: 27487473.
