Abstract :
Uterine rupture is a rare but severe obstetric emergency, often associated with previous uterine surgeries such as cesarean section or myomectomy. However, spontaneous rupture at an unscarred or remote uterine site is even rarer and often unpredictable. This condition poses a significant threat to both maternal and fetal well-being, requiring prompt diagnosis and surgical management. We report the case of a 26-year-old gravida 5, para 3 woman at 38 weeks and 4 days gestation who presented with bleeding per vaginum and absent fetal movements after undergoing a trial of labor after cesarean (TOLAC) at a peripheral center. On laparotomy, a 6 x 3 cm rupture was identified at the fundoposterior wall of the uterus, with the previous lower segment cesarean scar found intact. The fetus and placenta were extruded into the abdominal cavity. The uterus was repaired, and bilateral tubal ligation was performed. The patient recovered uneventfully postoperatively and was discharged on the fifth day.This case highlights the potential for uterine rupture to occur at non-scarred sites, possibly due to unrecognized prior uterine trauma such as silent perforation. TOLAC should be conducted with caution, ideally in well-equipped centers with surgical and transfusion capabilities. High clinical suspicion, early diagnosis, and prompt intervention are essential to minimize maternal morbidity and mortality in such rare presentations.
Keyword :
Uterine rupture, TOLAC, Fundal rupture, Intact scar, Obstetric emergency, Maternal morbidity, Silent uterine perforation.