Unusual case of spontaneous uterine rupture in a single gestational primipara

Spontaneous rupture of the primiparous uterus is a rare but catastrophic obstetrical emergency. It is usually associated with prior uterine surgery, trauma, or placental abnormality. To remind physicians to include this condition in their differential diagnosis of acute abdominal pain in pregnant patients, we describe an interesting case of spontaneous uterine rupture that clinically mimicked bowel perforation. A 27-year-old single primiparous pregnant woman presented with sudden onset of severe abdominal pain and peritoneal signs, with absence of vaginal bleeding at 26 weeks' gestation. The usual risk factors for uterine rupture, such as advanced maternal age, scarred uterus due to mode of previous delivery, or unusual pregnancy, were not present in our patient. Based on clinical examination, abdominal sonography and magnetic resonance imaging, uterine rupture was suspected and eventually confirmed at exploratory laparotomy. No uterine pathological abnormality was noted on the microscopic examination The preterm newborn expired after surgery. Since surgical intervention is the only definitive treatment, emergency physicians should be aware of this rare complication. Emergency physicians should be aware of spontaneous uterine rupture in pregnant patients, even in the absence of risk factors.