Uterine rupture occurs when there is complete or partial separation of the uterine wall. It is associated with increased morbidity and mortality for both the mother and the infant. A pregnant woman presents to the emergency room complaining of two weeks of abdominal pain at 17 weeks gestation. She was evaluated in an outlying emergency department when she became unstable and was transferred to a tertiary care center. A bedside ultrasound as well as commuted tomography revealed an extrauterine fetus, and she was taken to the operating room for exploratory laparotomy. Surgery revealed complete uterine rupture at the fundus with the fetus expelled into the abdomen. This case offers review of a rare outcome of uterine rupture during the second trimester and risks factors to be monitored for futures cases. 

Uterine rupture is classified as complete or partial separation of the uterine walls and is often associated with high morbidity and mortality. There are several risks factors for uterine rupture with the most common being separation of a previous hysterotomscar. Other risks factors include trauma, injury, prior myomectomy or other uterine surgeries, or uterine anomalies. Spontaneous rupture comprises a few as 1 in 15,000 deliveries. Uterine rupture in the second trimester is very rare, especially without predisposing risk factors. While uterine rupture in a patient with a prior cesarean section often occurs at the site of the prior hysterotomy scar, a case of a patient with rupture in a location unrelated to her scar is noteworthy for the literature. This is a case of a patient with a history of two prior low transverse cesarean sections who presented with a fundal uterine rupture at seventeen weeks gestational age leading to fetal demise.

With Regards,
Sara Giselle
Associate Managing Editor    
Journal of Critical Care Obsestrics & Gynocology