Spontaneous second-trimester uterine rupture in an unscarred uterus: A case report and review of literature

Spontaneous uterine rupture in the second trimester is an extremely rare but critical obstetric emergency, associated with significant maternal and foetal morbidity and mortality. A 41-year-old multiparous woman presented at 16 weeks of gestation with acute lower abdominal pain and vaginal bleeding. Initial evaluation revealed severe anaemia and haemodynamic instability. Imaging demonstrated massive hemoperitoneum and a possible placental abruption, necessitating emergency surgical intervention. Emergency laparotomy revealed a uterine fundal rupture with active bleeding and a bulging amniotic sac. The foetus was evacuated via a midline vertical uterine incision. A two-layer repair of the uterine defect was performed and the patient was admitted to intensive care for postoperative monitoring. She recovered well and was discharged free of complications. This case emphasizes the importance of early recognition and timely surgical intervention in the management of spontaneous second-trimester uterine rupture to prevent severe adverse outcomes.