Discussion:
Clinical signs of uterine rupture
in early pregnancy are nonspecific and must be distinguished from acute
abdominal emergencies. Abdominal pain, vaginal bleeding, and vomiting
are classic findings. Differential diagnoses are bleeding corpus luteum,
heterotropic pregnancy, and other surgical causes of acute abdomen(6).
Sometimes ultrasound has limited value and urgent surgery is necessary
to prevent catastrophic sequelae. An emergency laparoscopy or laparotomy
is needed for the correct diagnosis and to enable the necessary
treatment to take place. Early proper management are necessary to
decrease the high maternal and fetal mortality and morbidity rates
associated with uterine rupture. In our case, the diagnosis was not
clear. We performed emergency laparotomy after judging that laparoscopic
instrumentation was deficient because of the unstable vital signs of the
patient. Early surgical intervention is usually the key to successful
treatment of uterine rupture.
Few cases cited in the literature were diagnosed after postmortem on
autopsy. The clinicians were misled by the ultrasound finding of an
intrauterine pregnancy, and searched for other non-gynaecological causes
which delayed the management. (5)
Clinicians, especially first liners, should be aware of anatomical
changes in pregnancy as the uterus is enlarged and becomes an abdominal
organ. In evaluating pregnant lady, mild abdominal pain or discomfort
may be acceptable, but severe sudden pain associated with vomiting, sign
of peritoneal irritation, and possible obstetric etiology should be
considered seriously.(7)
No conflict of interests to be declared.
Funding: Not applicable.
Patient’s consent for permission to publication was obtained verbally.
Author: SI, clinician involved in
patient care, literature review, main author.