Rupture of the pregnant uterus refers to complete disruption of all uterine layers, including the serosa [1]. It is an Obstetric catastrophe associated with high maternal and perinatal morbidity and mortality [2]. It is a common complication in the developing countries due to poor obstetric care, low socioeconomic status, ignorance and adverse sociocultural practices, beliefs and aversion for Caesarean section [2].

1. Oyaromade A1*
, Fasanu OT2
, Usman M S1
, Isah M B1
, Ekele O I1
, Egwuete CO1
and Mohammed BA2
1
Department of Obstetrics and Gynaeology, Ahmad Sanni Yariman Bakura Specialist Hospital, Gusau, Zamfara State, Nigeria
2
Department of Obstetrics and Gynaecology, Federal Medical Centre, Gusau, Zamfara State, Nigeria
*
Corresponding author:
Abidemi Oyaromade,
Department of Obstetrics and Gynaeology,
Ahmad Sanni Yariman Bakura Specialist
Hospital, Gusau, Zamfara State, Nigeria,
Tel: +2348030775580;
E-mail: abidemioya@yahoo.com
Received: 19 Nov 2022
Accepted: 26 Dec 2022
Published: 03 Jan 2023
J Short Name: COS
Copyright:
©2022 Oyaromade A, This is an open access article dis-
tributed under the terms of the Creative Commons Attri-
bution License, which permits unrestricted use, distribu-
tion, and build upon your work non-commercially.
Citation:
Oyaromade A. Atypical Presentation of Spontaneous
Uterine Rupture Following a Spontaneous Vaginal
Delivery. Clin Surg. 2022; 8(7): 1-3
Atypical Presentation of Spontaneous Uterine Rupture Following a Spontaneous Vaginal
Delivery
Clinics of Surgery
Case Report ISSN: 2638-1451 Volume 8
clinicsofsurgery.com 1
1. Introduction
Rupture of the pregnant uterus refers to complete disruption of
all uterine layers, including the serosa [1]. It is an Obstetric ca-
tastrophe associated with high maternal and perinatal morbidity
and mortality [2]. It is a common complication in the developing
countries due to poor obstetric care, low socioeconomic status, ig-
norance and adverse sociocultural practices, beliefs and aversion
for Caesarean section [2].
We are reporting a case of spontaneous uterine rupture following a
spontaneous vaginal delivery that was managed at the department
of Obstetrics and Gynaecology, Ahmad Sanni Yariman Bakura
Specialist Hospital, Gusau, Zamfara state, Nigeria.
2. Case Presentation
Mrs A. A, a 25-year-old unbooked P4+0(2 alive) who had an un-
supervised home delivery of a fresh male stillborn 9 days prior
to presentation. She presented to the Obstetric emergency with
lower abdominal pain of 9 days, fever, headache and diarrhoea of
8 days, no excessive vaginal bleeding. On examination, she was
ill-looking, Temperature was 39.3°C, Pulse rate was 89bpm, BP-
120/90mmHg, there was generalized abdominal tenderness and
she had normal lochia on vaginal examination. PCV was 32%.
Ultrasound showed that pelvic organs were within normal limits
but there was increased peritoneal fluid. She was admitted for pu-
erperal sepsis and placed on parenteral antibiotics and analgesics.
1 day into admission, she was reviewed, she was still having ab-
dominal pain and fever, on examination she was not pale, she had
tinge of jaundice, pulse rate was 86bpm, BP- 120/90mmHg, ab-
domen was tender, uterus was difficult to palpate, percussion note
was dull. The cervix was 6cm dilated. Ultrasound scan and PCV
was to be repeated.
Day 2 into admission, she was still having fever, abdominal disten-
tion and pain. The repeat ultrasound scan showed a bulky uterus
and a discontinuation in the lower part of the posterior wall of the
uterus with massive peritoneal fluid, repeat PCV was 31%. On ex-
amination, she was not pale, had a tinge of jaundice, temperature
was 38.0°C, pulse rate was 116bpm, BP- 110/80mmHg, there was
generalized abdominal tenderness. On peritoneal tapping altered
blood was obtained (Figure 1).
She subsequently had an emergency exploratory laparotomy with
a midline sub-umbilical incision. Findings were massive haemop-
eritoneum of 2 litres, bulky uterus with left posterolateral rupture
from the isthmus to the left cornu, gangrenous left fallopian tube
and ovary, cheesy omental cake covering the uterus and the in-
tra-abdominal organs. She had a total abdominal hysterectomy,
left salpingo-oophorectomy and peritoneal toileting with a drain.
She had 500mls of whole blood transfused intra-operatively. She
was placed on antibiotics, IV fluids and analgesics. Drained was
removed 2 days post op when it was no longer active. She did re-
markably well and was discharged 1-week post op in good health
condition.

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Volume 8 Issue 7 -2022 Case Report
3. Discussion
Uterine rupture is an uncommon complication of pregnancy, it’s
prevalence varies from one region and country to another.3 It is
rare in developed countries, however, it is a menace to developing
countries especially in Africa where studies put the range between
0.3-2.4% [3-8].
In the developing countries, majority of cases of uterine rupture
occur following prolonged obstructed labour whereas in devel-
oped countries, it occurs more often with a history of previous
uterine surgeries [4, 9]. Other risk factors for uterine rupture are,
injudicious uterotonic use3, grand multiparity, macrosomia [10,
11] abnormal placention [12, 13], and drug abuse [14, 15]. How-
ever, none of these was identified in the patient presented.
Though majority of cases of uterine ruptures are diagnosed in the
intrapartum period, only a few cases are diagnosed in the post-
partum period [16]. Also, most patients present with the typical
features of sudden abdominal pain, vaginal bleeding, deranged
maternal vital signs and fetal heart rate abnormality or death, but
a few cases do not present this way [17]. In the case presented
above, the patient presented 9 days after a spontaneous vaginal
delivery, she had no vaginal bleeding nor any haemodynamic in-
stability, this contributed to the delay in making the diagnosis of a
uterine rupture.
Due to the rare occurrence and the atypical presentation of low-
er abdominal pain, fever, headache and diarrhoea, and findings of
normal vital signs with no vaginal bleeding our primary diagnosis
was puerperal sepsis. Ultrasound scan showing massive intraperi-
toneal fluid and a peritoneal tap yielding altered blood subsequent-
ly raised the diagnosis of a uterine rupture.
The pathogenesis of the rupture was not known, however with the
practice of fundal pressure being very common in our environ-
ment18, she might have sustained the uterine rupture in the second
stage of labour on account of fundal pressure, this was probably
the reason she subsequently progressed to a spontaneous vaginal
delivery of a fresh still birth. A similar case was reported in Taiwan
[19]. It is however unclear why she had neither vaginal bleeding
nor haemodynamic instability despite massive haemoperitoneum
later detected on emergency laparotomy.
Most cases of uterine rupture could be prevented with good ante-
natal care, birth preparedness and complication readiness, early
recognition of obstructed labour, close monitoring of interventions
known to have increased risk of uterine rupture [20]. Prompt di-
agnosis and treatment would prevent the accompanying morbidity
and/or mortality.
In conclusion, uterine rupture is an uncommon complication of
pregnancy with high maternal and perinatal morbidity and mortal-
ity. They may present with unusual signs and symptoms making
it tough to diagnose with history and physical examinations only.
However, there should be a high index of suspicion of uterine rup-
ture in a pregnant woman or in the puerperium with severe gener-
alized abdominal with or without vaginal bleeding.
Figure 1:
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