A rare correlation between Spontaneous Uterine Rupture (UR) and Adenomyosis

A report describes a case of a 27-year-old primigravid woman in the 22nd week of gestation, parity 0/0/0/0 with no relevant medical history, who presented with acute abdominal pain. 

The ultrasound revealed normal fetal biometrics for the gestational age, anterior normo-implanted placenta, and inhomogeneous uterus due to diffuse adenomyosis. 

The patient’s clinical condition worsened after hospitalization. She was conscious but then suddenly became pallid and asthenic, with a BP of 100/50 mmHg, HR of 110 bpm, rhythmic pulse, and an obstetric shock index (OSI) of 0.9. The fetal heart rate pattern showed evidence of severe fetal bradycardia of 70–80 bpm. An ultrasound revaluation showed a single fetus and a placenta expelled into the abdomen with free peritoneal fluid, suggesting UR and indicating immediate operation.

Her opened abdomen showed a massive hemoperitoneum with the whole gestational sac outside of an irregular breach (around 8 cm) on the uterine fundus.

900 mL of blood was drained, and the gestational sac showed a stillborn fetus with a weight of 460 g and placenta. The crack was about 8 cm and located close to the insertion of the right tube. 

The extensive and irregular uterine laceration and uncontrolled hemostasis indicated hysterectomy with conservation of the adnexa. Histological examination of the uterus displayed an extensive transmural diffused adenomyosis, particularly of the anterior wall of the uterus, with an area of hemorrhage of the surrounding myometrium on the uterine fundus that corresponded with the site of UR.

The patient received packed red blood cells with intravenous iron and a full course of intravenous antibiotics (cefazolina 3 g /day e.v.). She was discharged on the seventh postoperative day after counseling.

Vimercati A, Dellino M, Suma C, Damiani GR, Malvasi A, Cazzato G, Cascardi E, Resta L, Cicinelli E. Spontaneous Uterine Rupture and Adenomyosis, a Rare but Possible Correlation: Case Report and Literature Review. Diagnostics. 2022; 12(7):1574. https://doi.org/10.3390/diagnostics12071574