Case Report: Catastrophic Uterine Rupture in a Twin Pregnancy at 32+5 weeks

Uterine rupture is a life-threatening obstetric complication associated with significant maternal and perinatal morbidity and mortality. Maternal mortality remains a major concern worldwide and continues to be high in most of sub-Saharan Africa [1]. Women with a previous classical uterine incision are at greater risk of rupture compared with those who have undergone low transverse cesarean section [1]. Clinical signs may include abdominal pain, non-reassuring fetal heart patterns, and loss of fetal station, most commonly arising from a uterine scar defect after cesarean delivery [2]. Additional risk factors include a history of uterine surgery (e.g., myomectomy), shortened inter-delivery interval, gestational age greater than 40 weeks, and fetal macrosomia (>4000 g) [2]. During pregnancy, physiologic changes can obscure the diagnosis of acute abdomen. Symptoms such as nausea, vomiting, and abdominal discomfort may overlap with normal pregnancy complaints, making it challenging to differentiate from severe intra-abdominal pathology [3]. Furthermore, fever may not always be present, and clinical examination alone may not be sufficient for diagnosis [3]. We present a case of catastrophic uterine rupture in a woman with a twin pregnancy and a history of previous cesarean sections.