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.