Uterine Rupture During Labour in a Primigravida

EDITORIAL COMMENT: We accepted this case for publication because it will interest readers. Certainly the woman had a haemoperitoneum and signs indistinguishable from a case of rupture of the uterus although technically this is not a rupture because the tear did not extend through the uterine wall to the endometrial cavity. The editor saw a patient some 38 years ago who had a haemoperitoneum and who came to laparotomy on 2 occasions where it appeared that the bleeding had come from a tear in the peritoneum between the uterosacral ligaments. This patient died during her third laparotomy. There is also literature describing tears in the peritoneum over the uterosacral ligaments as a cause of chronic pelvic pain. The editorial committee find it feasible that a patient in labour can develop a tear in the peritoneum and superficial myometrium in her posterior uterine wall which if it involved vessels could cause a life-threatening haemoperitoneum. Of course similar tears occur due to trauma such as a motor-car accident when the woman is wearing a seat belt which can localize trauma to the uterus.
Summary: Uterine rupture ie extremely rare in the absence of any of the commonly recognized risk factors. We describe here a case of incomplete uterine rupture in a woman in her first pregnancy who had no previous instrumentation to the genital tract. Her only significant history was that of 2 episodes of minor antepartum haemorrhage occurring prior to induction of labour with artificial rupture of membranes and intravenous oxytocin. The rupture was manifested by 450 mL blood in the peritoneal cavity when an emergency Caesarean section was performed for persistent fetal bradycardia.