Atypical Presentation of Uterine Rupture at 13 Weeks Gestation Following Misoprostol Therapy: A Case Report and Review of Literature

Abstract Uterine rupture in the first trimester is an exceptionally rare but serious complication, particularly in patients with a history of prior uterine surgery. This case report documents the successful management of a uterine rupture at 13 weeks gestation following misoprostol therapy for a missed miscarriage in a 35-year-old woman with a previous cesarean section. The patient, gravida 5 para 4, presented in routine antenatal follow-up with no symptoms, and a routine ultrasound revealed a missed miscarriage. Following the administration of two doses of oral misoprostol, the patient developed severe abdominal pain and hemodynamic instability. Immediate laparotomy confirmed a uterine rupture at the site of the previous cesarean section scar, with significant internal bleeding. The rupture was surgically repaired, and the patient made a full recovery. This case highlights the importance of close monitoring during medical termination of pregnancy in patients with scarred uteri, even in early pregnancy, and underscores the need for prompt surgical intervention in cases of suspected uterine rupture. Further research is required to refine protocols for the safe use of misoprostol in patients with a history of uterine surgery. Keywords: Uterine rupture, first trimester, misoprostol, cesarean section, missed miscarriage, uterine scar, early pregnancy, laparotomy, case report.