Introduction Rupture of a gravid uterus is a rare surgical and obstetric emergency. The most accredited definition is from Plauche et al.: “those cases of complete separation of the wall of the pregnant uterus with or without expulsion of the fetus” [1]. Uterine rupture is more prevalent in less developed than in developed countries [2]. Risks factors include pre- vious uterine surgery such as cesarean section, laparotomic or laparoscopic myomectomy, hysteroscopic surgery, ia- trogenic uterine perforation, multiparity, previous instru- mental abortion, inappropriate augmentation of labor, application of fundal pressure, placenta accreta, trauma, and congenital uterine anomalies [2-5]. It is possible to classify uterine rupture according to etiology: a) sponta- neous rupture of previous scar (cesarean section, myomec- tomy etc); b) traumatic rupture of previous scar (version in obstetrics, accident, etc); c) spontaneous rupture of un- scarred uterus; d) traumatic rupture of unscarred uterus. Symptoms of uterine rupture are severe abdominal pain of sudden onset, palpable fetal body parts, cessation of contractions, signs of intraperitoneal bleeding, and all the features correlated to the hemorrhage that could lead to maternal and fetal (fetal distress, bradycardia) deteriora- tion of vital signs leading up to shock. Less common symptoms are epigastric pain, shoulder pain (right-sided or bilateral), abdominal distension and paralytic ileus, ematuria, hypertonic uterus, altered uterine contour, and fluid thrill. Often there is minimal external bleeding but an important internal bleeding with blood in the broad lig- ament and extaperitoneal spaces could be detected with an ultrasound examination. The typical ultrasound manifes- tations of uterine rupture are the empty uterus and the ges- tational sac above the uterus. Other sonographic findings are intrauterine blood and large uterine mass with gas bub- bles [6]. Hruska et al. reported the importance of the MRI examination for assessment of pregnant patients in case of uterine rupture [7]. Treatment of uterine rupture is an early surgical intervention and previous hemodynamic stabi- lization of the patient where possible. It is necessary to cor- rect hypovolemia after securing airway and oxygen administration. Maternal mortality is 0.44% and it resulted from hemorrhage, shock, sepsis, disseminated intravascu- lar coagulation, pulmonary embolism, ileus paraliticus, peritonitis. and renal failure. It is possible to reduce fetal and maternal mortality with a prompt intervention, less than 18 minutes from onset of prolonged deceleration to delivery [8]. The authors present two cases of a sponta- neous complete uterine rupture at a gestational age of 27 weeks in a 29-year-old patient and 34 weeks in a 38-year- old patient after previous misunderstood perforation. The cases were managed at the University of Cagliari (Hospi- tal San Giovanni di Dio, Cagliari). The first case had a past history of dilatation and curet- tage for abortion. The second case had a past history of di- Revised manuscript accepted for publication April 23, 2015 Uterine rupture in pregnancy: two case reports and review of literature A. Pontis 1 , C. Prasciolu 1 , P. Litta 2 , S. Angioni 1 1 Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari 2 Department of Obstetric and Gynecology, University of Padua, Padua (Italy) Summary Rupture of a gravid uterus is an obstetric emergency. Risks factors include a scarred uterus but also spontaneous rupture of an un- scarred uterus during pregnancy is possible. The authors present two cases of a spontaneous complete uterine rupture during pregnancy. The first case had only a past history of dilatation and curettage for abortion; the second case had a past history of dilatation and curet- tage for abortion and a monolateral laparoscopic salpingectomy for ectopic pregnancy. They presented with abdominal pain and after ultrasound scan, uterine ruptures were diagnosed. These cases show that there should be a high index of suspicious of uterine rupture in a gravid woman with a history of curettage for the possible presence of misunderstood uterine scar and in women with a past history of salpingectomy with or without corneal resection. Appropriate counseling and close follow-up might help to avoid such obstetrical catastrophes. To provide more insight into the possible risk factors for prelabor uterine rupture in pregnancy, a literature review was per- formed. Key words: Uterine rupture; Dilatation and curettage; Uterine scar. CEOG Clinical and Experimental Obstetrics & Gynecology 7847050 Canada Inc. www.irog.net Clin. Exp. Obstet. Gynecol. - ISSN: 0390-6663 XLIII, n. 2, 2016 doi: 10.12891/ceog3066.2016