Spontaneous second trimester uterine rupture after classical cesarean.
BACKGROUND
Several cases of spontaneous second trimester uterine rupture have been reported, but none as early as 15 weeks' gestation after classical cesarean and with placenta percreta.


METHODS
A 23-year-old woman, gravida 5, para 3, at 15 37 weeks' gestation with a history of classical cesarean incision presented to the emergency department with abdominal pain, hypotension, and tachycardia. Ultrasound showed a normal intrauterine pregnancy. She developed worsening pain, abdominal rebound, and abdominal distention. On exploratory laparotomy, a large uterine rupture was found and hysterectomy was done.


CONCLUSIONS
Spontaneous uterine rupture after classical cesarean can occur as early as 15 weeks' gestation. Uterine rupture must be considered in differential diagnoses of severe abdominal pain even in the early second trimester.
Endres
L K
LK
Center for Reproductive Medicine and Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. l-endres@nwu.edu
Barnhart
K
K
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011272:Pregnancy, Multiple; D014597:Uterine Rupture / Q000150:complications / Q000175:diagnosis / Q000209:etiology*