Arch Gynecol Obstet (2010) 281:999–1001 DOI 10.1007/s00404-009-1321-8 123 MATERNO-FETAL MEDICINE Spontaneous rupture of unscarred uterus at 27 weeks of gestation Isil Uzun · Alkan YÂldÂrÂm · Ibrahim Kalelioglu · Recep Has Received: 29 July 2009 / Accepted: 1 December 2009 / Published online: 22 December 2009  Springer-Verlag 2009 Introduction Spontaneous rupture of a gravid uterus is a life-threatening obstetric emergency with high maternal mortality and morbidity, perinatal mortality and loss of future fertility as hysterectomy maybe inevitable in most cases. Most sponta- neous uterine ruptures occur during labor in parturients with a scarred uterus. Rupture of unscarred uterus is a rare event involving 1/17,000–20,0000 and occur more fre- quently in older multiparous patients [1–3]. Here, we pres- ent a case of spontaneous rupture of uterus in a primigravid woman which was successfully repaired. Case report History A 32-year-old primigravid woman was admitted with abdominal pain that began 6 h earlier and premature uterine contractions at 27 weeks of gestation. She had no signiWcant past medical history and any risk factor for uterine rupture. Examination The cervix was 1 cm dilated and 30% eVaced. Non-stress test showed 140–150 bpm heart rate with no decelerations and a contracting uterus at a rate of 3–4/10 min. Clinically she appeared ill but was hemodynamically stable (pulse 80 bpm and regular blood pressure 100/60 mmHg). Hema- tologic parameters including coagulation proWle were nor- mal (hemoglobin 9.2 g/dl, white cell count 14 £ 10/l, platelet count 168 £ 10/l). The abdomen was soft but slight tenderness and guarding was elicited in right iliac fossa. Ultrasound showed a viable fetus with cephalic presenta- tion and normal biometry consistent with gestation. Placenta was arterially situated with no evidence of abruption. Treatment Tocolysis with nitroglycerin was commenced to abate uter- ine contractions. Consultation with general surgery unit was made to rule out surgical pathology. One hour later the fetus developed progressive heart rate decelerations. While revaluating, abdominal pain was noticed and that prompted an emergency abdominal delivery. Surgical Wndings At the emergency laparotomy frank hemoperitoneum of approximately 1,000–1,500 ml fresh blood and clots was recovered. A vertical tear of about 10 cm long was found on the anterior uterine wall. Placenta and part of the fetus were extruded from the uterine cavity; 0.944 g female fetus was delivered through the ruptured site and Apgar scores were 2/6 at 1 and 5 min. The tear extended into two-thirds of anterior uterine wall. The uterine vessels were not torn, but small actively bleeding vessels at the ruptured site were present. Surgical treatment The tear was repaired in two layers by interrupted vicryl sutures which secured hemostasis and peritonization of the ruptured site was made. She was transfused with 4 units of I. Uzun (&) · A. YÂldÂrÂm · I. Kalelioglu · R. Has Obstetrics and Gynecology Department, Istanbul Medical Faculty, Istanbul University, Çapa, 34093 Istanbul, Turkey e-mail: isiluzu@gmail.com