title: Spontaneous rupture of unscarred uterus in a primigravida with preterm prelabour rupture of membranes.
abstract: Intrapartum uterine rupture is a true obstetrical emergency. Uterine rupture is associated with severe maternal and fetal morbidity and mortality. It is rare in the unscarred uterus of a primigravida. A 23-year-old primigravida with an unscarred uterus was admitted with preterm prelabour rupture of membranes at 36(+4) weeks of gestation. Abnormal fetal heart monitoring, associated with acute onset of severe abdominopelvic pain, developed on admission. Rupture occurred prior to onset of regular uterine contractions and in the absence of any interventional oxytocin. The neonate had evidence of severe acidosis despite emergency caesarean delivery. This case highlights the importance of maintaining a high index of suspicion for uterine rupture, even in the unlikely setting of a primigravida with an unscarred uterus.
authors.affiliation: Department of Community and Family Medicine, Obstetrics Fellowship Division and Family Medicine Residency Program, University of Missouri Kansas City, Kansas City, Missouri, USA.
authors.forename: Wael Sayed
authors.initials: WS
authors.lastname: Mourad
authors.affiliation: Department of Obstetrics and Gynecology, Truman Medical Center Lakewood, Kansas City, Missouri, USA.
authors.forename: Debbra J
authors.initials: DJ
authors.lastname: Bersano
authors.affiliation: Department of Obstetrics and Gynecology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Greenspan
authors.affiliation: Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Diane Medved
authors.initials: DM
authors.lastname: Harper
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D001919:Bradycardia / Q000209:etiology; D002585:Cesarean Section; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D012422:Rupture, Spontaneous / Q000175:diagnosis; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods; D014590:Uterine Contraction; D014597:Uterine Rupture / Q000175:diagnosis* / Q000601:surgery