Case Report: Rare case of first-trimester uterine rupture at 9 weeks' gestation following multiple hysteroscopic surgeries and a prior cesarean section.

Uterine rupture is a rare but life-threatening obstetric emergency, with most cases occurring during late pregnancy or labor, particularly in patients with a history of uterine surgery. This report presents an exceptionally rare case of spontaneous uterine rupture at 9 weeks' gestation in a 36-year-old woman with a complex surgical history, including a midtrimester cesarean delivery for placenta accreta and multiple subsequent hysteroscopic adhesiolysis procedures. The patient presented with acute abdominal pain and hemorrhagic shock, highlighting the diagnostic challenges of early gestational rupture, in which ultrasonographic findings may be nonspecific. Despite initially inconclusive imaging, prompt laparoscopic intervention confirmed a 4-cm anterior uterine wall rupture with significant hemoperitoneum, enabling successful laparoscopic repair and preservation of reproductive potential. This case highlights several critical clinical insights, including the potential cumulative weakening effect of multiple uterine interventions beyond classical cesarean scarring, feasibility of minimally invasive management in hemodynamically stable patients, and importance of maintaining a high index of suspicion in high-risk populations regardless of gestational age. This atypical presentation challenges conventional understanding of uterine rupture timelines and risk stratification, emphasizing the need for individualized assessments of uterine integrity in patients with complex surgical histories. This report contributes to the limited literature on first-trimester uterine rupture and underscores the evolving paradigm of diagnostic and therapeutic approaches for this catastrophic obstetric complication.