Spontaneous rupture of a bicornuate uterus

A report describes a case of a 21-year-old healthy primigravida woman who previously had no surgical operations and was at 19 weeks and five days of gestation without regular antenatal care visits. The woman presented with severe abdominal pain of two hours' duration, associated with progressive abdominal distension, dizziness, and shoulder tip pain. She described no associated vaginal bleeding.

Examination revealed the patient was unconscious, with a blood pressure of 70/40 mmHg, pulse rate of 130/min, and respiratory rate of 24/min. Abdominal examination revealed a distended abdomen reaching the xiphoid process and generalized abdominal tenderness. Abdominal ultrasound revealed a fluid-filled abdominal cavity with clots and a non-viable fetus. 

The clinical suspicion indicated a ruptured uterus, and the patient received immediate resuscitation with a decision made for emergency laparotomy.

Intraoperative findings revealed a massive hemoperitoneum of around two liters of blood and blood clots, a bicornuate uterus with a ruptured left horn at the fundus, in addition to a non-viable normal-looking fetus in the abdominal cavity. 

 The ruptured left horn was excised at its junction with the right horn, the defect resulting from the excision was sutured, and an intraabdominal drain was inserted. The woman received four units of packed red blood cells and four units of fresh frozen plasma. She had an uneventful recovery and received discharged home on the fourth postoperative day. 

Saleem HA, Edweidar Y, Salim MA, Mahfouz IA. Mid-trimester spontaneous rupture of a bicornuate uterus: A case report. Case Reports in Women's Health. 2023;39. https://doi.org/10.1016/j.crwh.2023.e00524.