Silent Uterine Rupture with the Use of Misoprostol for Second Trimester Termination of Pregnancy : A Case Report

Uterine rupture is an uncommon, but a life-threatening, complication following second trimester medical termination of pregnancy (TOP). The reported cases have been in both the scarred and unscarred uterus (Rajesh et al. 2002, Drey et al. 2006, and Dickinson). A 27-year-old with two previous deliveries, no previous caesarean section, no history of induced abortions, and no gynaecological operations. She presented with amenorrhoea, and according to her last normal menstruation, she was 10 weeks and 5 days. Ultrasound was done, and it reported 16 weeks and 5 days. She asked for TOP. According to the clinic's protocol, misoprostol 800？mcg (4 tabs) were given to be used vaginally as a loading dose and another three to be taken orally after that. In the following day when she attended the clinic for follow up, a manual vacuum aspiration (MVA). A manual vacuum aspiration was indicated as an incomplete abortion. During the procedure, a uterine rupture was found in the uterine lower segment. A laparotomy was done and a lineal uterine rupture was found and sutured. The patient had a good postoperative recovery and was discharged from hospital after four days. The clinician dealing with second trimester terminations should be aware of the possibility of having a uterine rupture, especially in patients with a uterine scar in order to make an early diagnosis. 1. Introduction Uterine rupture is an uncommon, but a life-threatening complication following second trimester medical termination of pregnancy (TOP). The reported cases have been in both the scarred and unscarred uterus [1–3]. The occurrence is about 0.2% in the intact uterus and 3.8 to 4.3% in the scarred uterus [1, 2]. 2. Case Report A 27 year-old woman with two previous deliveries, no history of previous caesarean section, no induced abortions, and no gynaecological operations, presented with amenorrhoea seeking for TOP in her third pregnancy. She had no pregnancy symptoms and no history of contraceptive use. According to her last normal menstrual period, her gestational age was ten weeks and six days. On physical examination, blood pressure was 110/70, and pulse was 76 beats per minute. Symphisis fundal height was 15？cm. An ultrasound scan was done. It reported 16 weeks and 5 days (Biparietal diameter, femur length, and abdominal circumference). The patient was counselled for termination of pregnancy; the methods, side effects, and complications were explained. Alternative options were also discussed. She opted for TOP. Based on the Choice of Termination of Pregnancy Act, 1996 (CTOP, Act 1996), her