A Case Report on an Atypical Uterine Rupture – Rupture During Miscarriage Management

Background: Uterine rupture is a severe obstetric complication traditionally associated with a past history of caesarean section or other factors causing uterine scarring. However, instances of atypical uterine rupture in patients have been reported. This case report present an atypical instance of uterine rupture in a patient with no known risk factors, emphasising the need for high suspicion for uterine rupture even in absence of risk factors. Case Presentation: The case discusses a gravida 3, para 2 female with no significant history, except for treatment for cervical intraepithelial neoplasia. No history of caesarean section or uterine scarring. Presented with light vaginal bleeding and later diagnosed with a miscarriage at 20+1 weeks of gestation. Managed with misoprostol per trust guidelines, the patient developed severe pain, signs of sepsis, and shock. An ultrasound revealed a heterogeneous mass in the lower uterine segment and free fluid in the pelvis. ACT scan confirmed a ruptured uterus with the foetus and placenta lying anteriorly and hemoperitoneum present. Alaparotomy was performed under general anaesthesia and the uterus was repaired. Postoperatively, the patient developed ileus and a pulmonary embolism, which were treated, leading to gradual recovery. Conclusion: This atypical case of uterine rupture highlights the need to maintain a high level of suspicion for uterine rupture, even in the absence of traditional risk factors. It also underscores the importance of careful patient management during labour induction with misoprostol, especially when complications arise. This case serves as a reminder to clinicians to consider all possible diagnoses when a patient's condition deteriorates, even in the absence of conventional risk factors. More research is needed on the use of labour-inducing drugs, particularly misoprostol, in the management of intrauterine foetal death.