First Trimester Spontaneous Uterine Rupture in a Young Woman with Uterine Anomaly

Spontaneous uterine rupture is a life-threatening obstetrical emergency carrying a high risk for the mother and the fetus. Spontaneous uterine rupture in early pregnancy is very rare complication and it occurs usually in scarred uterus. Uterine anomalies are one of the reasons for spontaneous unscarred uterine rupture in early pregnancy. Obstetricians must consider this diagnosis when a pregnant patient presented with acute abdomen in early pregnancy. We present a case of spontaneous uterine rupture at 12 weeks of gestation in 24-year-old multigravida who had uterine anomaly presenting as an acute abdomen. Our preoperative diagnosis was ectopic pregnancy. Emergency laparotomy confirmed a spontaneous uterine rupture. Uterine anomaly is a risk factor for spontaneous uterine rupture in the early pregnancy. Clinical signs of uterine rupture in early pregnancy are nonspecific and must be distinguished from acute abdominal emergencies. 1. Introduction Rupture of a pregnant uterus is one of the life-threatening complications associated with obstetric practice [1]. There are several risk factors associated with uterine rupture (UR), but the most common is a previous Cesarean section. Unscarred uterine rupture (UUR) is a rare event that usually occurs in late pregnancy or during labour. Risk factors for UUR include high parity, placental abnormalities, and uterine anomaly. UUR during pregnancy, especially before the end of the second trimester, occurs relatively rarely and is associated with high mortality and morbidity for both the fetus and mother. We here report a case of a spontaneous unscarred uterine rupture (SUUR) in early pregnancy, in a woman with a bicornuate uterus. 2. Case Report A 24-year-old woman was admitted to our department with 3-month amenorrhea and sudden, severe, generalized abdominal pain and vaginal bleeding of 2-hour duration. Her first pregnancy resulted in abortus at 8 gestational weeks, but no surgical procedure was performed. On physical examination, the patient was pale with a pulse rate of 130 beats per minute (bpm) and a blood pressure of 80/40？mmHg. The abdomen was tender. Ultrasound examination revealed a 12-week consistent, fetal heartbeat negative pregnancy in the left tuboovarian area and free fluid in the Douglas pouch. Haemoglobin concentration was 7？g/dL. Due to unstable vital signs, two units of screened blood were cross-matched, and the patient was rushed to the operating room. Our preoperative diagnosis was ectopic pregnancy. Laparotomy revealed haemoperitoneum of 1 liter. Further inspection showed a bicornuate uterus