Second-Trimester Uterine Rupture After Conservative Myomectomy: A Case Report and Institutional Perspective.

Uterine rupture following myomectomy represents a rare but severe complication of pregnancy, with a reported incidence of less than 1%. It most commonly occurs during the late second or third trimester and is associated with significant maternal hemorrhage and fetal compromise. We report the case of a 36-year-old G3P0 woman at 28 + 5 weeks of gestation with a history of prior laparoscopic myomectomy complicated by postoperative hemorrhage and sepsis, who presented with acute abdominal pain and hemodynamic instability. Emergency laparotomy revealed approximately 1000 mL hemoperitoneum and a 3 cm rupture of the posterior wall of the lower uterine segment. A live preterm neonate was delivered via cesarean section, followed by total hysterectomy due to extensive uterine pathology and ongoing hemorrhage. The postoperative course was uneventful, and the neonate required intensive care support. This case underscores the importance of maintaining a high index of suspicion for uterine rupture in pregnant patients with a history of uterine surgery and highlights the potential role of surgical technique and uterine wall reconstruction in determining subsequent scar integrity.