Spontaneous non-laboring uterine rupture of an unscarred uterus in a 44-year-old female patient lacking predisposing factors: a case report.

backgroundUterine rupture during gestation is an uncommon but serious complication involving a complete tear in all layers of the uterine wall. The median occurrence rate of this condition is estimated to be 5.3 per 10,000 total births. This condition is strongly associated with scarred uterus, with approximately 90% of ruptures occurring in women who have had prior uterine surgery while spontaneous uterine rupture of unscarred uterus is exceedingly rare and is a considerably more severe complication, posing a clinical challenge to obstetricians and prompting immediate diagnosis and management to manage the massive hemorrhage. CASE PRESENTATION: A 44 year-old gravida 3, para 2 Syrian woman at 36 weeks of pregnancy presented with complaints of generalized fatigue and mild lower abdominal pain. The patient reported a sudden onset of severe abdominal pain approximately 2 hours prior to arrival, which resolved spontaneously. She had no significant medical history. On gynecological examination, the patient was not in labor and ultrasound examination demonstrated extramural fetus with a contracted and involuted uterus along with free intraperitoneal fluid, substantially corroborating the diagnosis of spontaneous uterine rupture in the absence of predisposing factors. Our patient underwent exploratory laparotomy, during which the deceased fetus and the placenta were removed from the peritoneal cavity, followed by total hysterectomy, and the follow-up course was uneventful.

conclusionSpontaneous non-laboring uterine rupture of unscarred uterus may unexpectedly occur even in the absence of predisposing factors. The clinical suspicion is key to avoid confusion with other differential diagnoses. Clinicians must remain vigilant about the atypical presentations of uterine rupture to avoid delayed diagnosis and management of uterine rupture. Ultrasound may substantially corroborate the preoperative diagnosis. Hysterectomy remains the preferred management in cases of severe uterine ruptures.