Spontaneous uterine rupture in a primigravid woman in the early third trimester attributed to adenomyosis: A case report and review of the literature

Successful treatment of large adenomyosis with transcervical radiofrequency ablation in a high-risk patient: A case report and short review

Adenomyosis is a prevalent gynecological condition that affects women of reproductive age, and its treatment can present significant challenges. Conventional surgical approaches are traumatic to the uterine tissue, necessitating the development of alternative methods. We herein describe the successful treatment of a large diffuse adenomyosis on the back wall of the uterus in a high-risk patient with severe symptoms and fertility desire, using transcervical intrauterine ultrasound-guided radiofrequency ablation. The treatment significantly reduced uterine and adenomyosis volumes and improved the symptoms. This method is a minimally invasive uterine-preserving option and serves as a promising therapeutic alternative to conventional procedures, such as hysterectomy and tissue excision, for treating adenomyosis.

A case report of adenomyosis-induced spontaneous rupture in an unscarred and unpregnant uterus

RATIONALE

Spontaneous uterine rupture, although rare, is a life-threatening obstetric emergency with a high maternal and fetal mortality rate. It can occur without warning, leading to severe complications, including hemorrhage, shock, and fetal demise. The risk factors contributing to uterine rupture are diverse and include a history of uterine surgery (such as cesarean section), trauma to the uterus, abnormal uterine contractions during labor, and underlying conditions like adenomyosis. Identifying and understanding these risk factors are crucial for early detection, timely intervention, and improved outcomes in affected pregnancies.

PATIENT CONCERNS

Here, we report an exceptionally rare case of spontaneous uterine rupture triggered by adenomyosis in a 34-year-old unmarried and nulliparous woman with no prior scarring or pregnancy. Physical examination revealed abdominal distension, with the uterine fundus at the level of the umbilicus, exhibiting hardness, tenderness upon palpation, and rebound tenderness. Ultrasonography and computerized tomography scans suggested adenomyosis and uterine rupture. During surgery, a rupture was discovered in the left basal layer of the uterus, with a rupture diameter of approximately 3 cm. Additionally, there were multiple internal endometrial lesions in the uterorectal pouch.

DIAGNOSES

Adenomyosis-induced spontaneous uterine rupture.

INTERVENTIONS

The procedures performed included excision of adenomyotic lesions, repair of the uterine rupture, and electrocoagulation of endometriotic lesions in the pelvic cavity.

OUTCOMES

At the 1-month post-surgery follow-up examination, the patient showed good recovery, with no signs of complications. She was able to resume normal daily activities without difficulty. The surgical site was healing well, with no signs of infection or abnormal scarring. Ultrasound and clinical assessments confirmed the resolution of pelvic fluid accumulation, and uterine function appeared to be intact. The patient was advised to continue regular follow-up visits to monitor her recovery and ensure long-term well-being.

LESSONS

First, uterine rupture caused by adenomyosis in a nonpregnant, scarless uterus is extremely rare but still possible. When patients with severe adenomyosis present with abdominal pain and pelvic fluid, obstetricians and gynecologists should consider the possibility of uterine rupture. Second, ultrasound examination can quickly and accurately diagnose both adenomyosis and uterine rupture.

Early Labor Posterior Uterine Wall Rupture in a Primigravid Mother with Successful Repair and Live Birth: A Case Report

Background

Posterior uterine wall rupture is extremely uncommon in the absence of any of the commonly recognized risk factors. Even though uterine rupture is more likely in multiparous people, it cannot be believed that the uterus of a primigravid is impervious to rupture. The objective of this case report is to alert obstetricians about atypical posterior uterine wall rupture presentation in the absence of identifiable risk factors and to emphasize the worth of prompt action.

Case Presentation

A 22-year-old primigravid mother with a 12 cm vertical posterior uterine wall rupture of an unscarred uterus at St. Paul's Hospital in Ethiopia was reported to have survived an intrapartum uterine rupture during the latent early stage of labor while taking a low dose of oxytocin. The baby was saved from the abdominal cavity after an emergency laparotomy was performed. Complete hemostasis was achieved when the posterior uterine wall rupture was repaired in two layers. The patient and her baby were discharged on the fifth postoperative day smoothly.

Conclusion

Posterior uterine wall rupture in a primigravid mother with an unscarred uterus is extremely rare, but a high index of suspicion should be kept in mind as expedited intervention is the only way to save the mother and fetus.

Association between endometriosis and obstetric complications: Insight from the National Inpatient Sample

OBJECTIVE

This study aimed to investigate the relationship between endometriosis and adverse obstetric outcomes using data from the National Inpatient Sample (NIS) database.

METHODS

The ICD-10 coding system was used to identify codes for endometriosis and obstetric outcomes, and data from the NIS (2016-2019) were analyzed. Descriptive statistics were used to summarize variables, while the chi-square test was used to detect significant differences for categorical variables. Univariate and multivariate regression analyses were conducted to assess the association between endometriosis and obstetric outcomes. On multivariate analysis, adjustment was done for age, race, hospital region, smoking status, and alcohol misuse. Forest plots were used to visualize odds ratios and their 95% confidence intervals.

RESULTS

Overall, 2,854,149 women were included in this analysis, of whom 4,006 women had endometriosis. The post-hoc Bonferroni correction was applied to account for multiple comparisons, and our analyses revealed several statistically significant associations (p < 0.004). Specifically, on univariate analysis, significant associations with endometriosis were identified for ruptured uterus, placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, gestational diabetes, preterm labor, and multiple gestation. On multivariate analysis, significant associations with endometriosis were observed for placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, preterm labor, premature rupture of membranes, and multiple gestation.

CONCLUSION

The present findings provide important insights into the potential relationship between endometriosis and various adverse obstetric outcomes and may help inform clinical practice and future research. Further studies that use more detailed clinical data and longitudinal designs are needed to solidify the presented conclusions.

Uterine rupture of an unscarred gravid uterus at term attributed to adenomyosis

Uterine rupture is a rare obstetric emergency that is typically associated with the presence of scar tissue such as in the case of previous caesarean section. In this case report, a primigravid patient presented to the hospital in cardiac arrest with massive haemoperitoneum secondary to a posterior uterine rupture. The histological specimen was found to have diffuse adenomyosis at the site of rupture. On review of the literature, there is insufficient evidence to suggest we as clinicians should alter the antenatal care for patients with known adenomyosis; however, this case highlights how we should have a high index of suspicion for those presenting with signs and symptoms of uterine rupture with known adenomyosis in the absence of other risk factors.

Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Importance

Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes.

Objective

To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus.

Evidence Acquisition

PubMed was searched for the phrases "uterine rupture," "unscarred," and "spontaneous." Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included.

Results

We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries.

Conclusions and relevance

Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy.

Uterine rupture due to adenomyosis in an adolescent: A case report and review of literature

BACKGROUND

Uterine rupture is a fatal medical complication with a high mortality rate. Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures. Adenomyosis is a possible risk factor for uterine rupture. However, spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.

CASE SUMMARY

A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg. Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung, suggesting lung metastasis. The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules. Histologically, the uterus showed diffuse adenomyosis with glandular and stromal dissociation. Lung nodules were endometrioma with massive hemorrhage. Immunohistochemistry demonstrated that the tumor cells were positive for PAX8, ER, and PR expression, leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis. Following surgery, the patient remains in good condition without recurrence.

CONCLUSION

This is the first case of spontaneous uterine rupture due to adenomyosis in a non-gravida adolescent.

Spontaneous rupture of the uterus in the third trimester after high-intensity ultrasound ablation in adenomyosis: A case report

Adenomyosis is a benign uterine disease. Due to the higher incidence of adenomyosis and patients' demands for fertility, high-intensity ultrasound ablation has been widely used in gynecological patients with uterine fibroids and adenomyosis. Ultrasound ablation of lesions can help alleviate symptoms in patients without increasing the incidence of obstetric complications in subsequent pregnancies. High-intensity ultrasound ablation is not considered a risk factor for uterine rupture. However, we describe a case of adenomyosis treated with high-intensity ultrasound ablation presenting with uterine rupture in the third trimester. The patient underwent an emergency cesarean section to deliver the baby successfully and underwent uterine repair surgery. When treating patients with adenomyosis, care should be taken to protect the myometrium, endometrium, and serous layer to reduce the risk of uterine rupture.

Spontaneous Uterine Rupture and Adenomyosis, a Rare but Possible Correlation: Case Report and Literature Review

(1) Background: Uterine rupture during pregnancy is a serious obstetric complication with a high incidence of maternal morbidity and mortality. (2) Methods: The present case is a rare event of a uterine rupture occurring in an unscarred uterus in a nonlaboring primigravida woman in the second trimester. The only risk factor in this case was adenomyosis found in the preconceptional phase. (3) Results: The diagnosis of adenomyosis can often be difficult, so patients should be evaluated by a specialized gynecologist. After careful amnestic collection, a gynecological examination and II level ultrasound should be performed in accordance with the Morphological Uterus Sonographic Assessment classification. (4) Conclusions: This evaluation allows us to identify classes of patients at high risk of uterine rupture who, therefore, must be properly informed of the risks both during preconceptional counseling and during pregnancy.

Imaging evaluation of uterine perforation and rupture

Uterine perforation and rupture, denoting iatrogenic and non-iatrogenic uterine wall injury, respectively, are associated with substantial morbidity,and at times mortality. Diverse conditions can result in injury to both the gravid and the non-gravid uterus, and imaging plays a central role in diagnosis of such suspected cases. Ultrasound (US) is the initial imaging modality of choice, depicting the secondary signs associated with uterine wall injury and occasionally revealing the site of perforation. Computed tomography can be selectively used to complement US findings, to provide a more comprehensive picture, and to investigate complications beyond the reach of US, such as bowel injury. In certain scenarios, magnetic resonance imaging can be an important problem-solving tool as well. Finally, catheter angiography is a valuable tool with both diagnostic and therapeutic capability, with potential for fertility preservation. In this manuscript, we will highlight the clinical and imaging approach to uterine perforation and rupture, while emphasizing the value of various imaging modalities in this context. In addition, we will review the multi-modality imaging features of uterine perforation and rupture and will address the role of the radiologist as a crucial member of the management team. Finally, a summary diagrammatic depiction of imaging approach to patients presenting with uterine perforation or rupture is provided.

Spontaneous unscarred uterine rupture in a twin pregnancy complicated by adenomyosis: A case report

INTRODUCTION

Uterine rupture during pregnancy is a serious obstetric complication accompanied by a high incidence of maternal morbidity and mortality, and the presence of uterine scars is the main risk factor. In the present case, uterine rupture occurred in an unscarred uterus in a nonlaboring primigravida woman with adenomyosis and twin pregnancy in the third trimester.

PATIENT CONCERNS

In this case, the patient suspected to have a history of endometriosis have got twin pregnancies following intracytoplasmic sperm injection, and complained of recurrent lower abdominal pain from 16 weeks to 29 weeks of gestation.

DIAGNOSIS

After exploratory laparotomy, the patient was diagnosed with uterine rupture and adenomyosis.

INTERVENTIONS

The patient was first administered expectant treatment such as antibiotics, tocolytics, and fluid replacement therapy. Symptoms then appeared repeatedly and worsened, followed by eventual peritoneal irritation, and exploratory laparotomy was performed.

OUTCOMES

Two live female fetuses were extracted by cesarean section, and the uterine laceration was repaired. The mother recovered without any postoperative complications, and the babies were discharged after receiving one month of prematurity care without any postnatal complications.

CONCLUSION

Adenomyosis and the conception of twins may lead to uterine rupture. For pregnant women with a history of adenomyosis with multiple gestations, close monitoring for signs of uterine rupture is necessary. Single-embryo transfer and multifetal pregnancy reduction should be recommended for infertile patients with adenomyosis.

Uterine wall rupture in a primigravid patient with oligohydramnios as the first manifestation: A case report

RATIONALE

Spontaneous uterine rupture during pregnancy, occurring most often during labor in the context of a scarred uterus, is a serious obstetric complication. Perhaps even more serious because of its extreme rarity, spontaneous uterine rupture in a primigravid patient with an unscarred gravid uterus would be essentially unexpected. Clinical manifestations of unscarred uterine ruptures are nonspecific and can be confusing, making a correct early diagnosis very difficult.

PATIENT CONCERNS

A primigravid woman at 27 weeks of gestation presented to our hospital with acute oligohydramnios. Ultrasound examination at her local hospital revealed oligohydramnios that had not been present 1 week previously. A specific cause of the acute oligohydramnios, however, was not established.

DIAGNOSIS

Upon transfer to our hospital, the patient was hemodynamically stable without abdominal tenderness or peritoneal signs. Transabdominal ultrasound was repeated and confirmed oligohydramnios and seroperitoneum. The fetal heart rate was in the normal range, and blood tests revealed a low hemoglobin level of 91 g/L, which had been normal recently. A repeat sonogram after admission found that there was almost no amniotic fluid within the uterine cavity, and there was increased peritoneal fluid. Repeat hemoglobin showed a further decrease to 84 g/L. The combination of increased free abdominal fluid, lack of intrauterine fluid, and acutely decreasing hemoglobin strongly suggested uterine rupture with active intraperitoneal bleeding.

INTERVENTIONS

Emergent laparotomy was performed, and a male infant was delivered. Comprehensive abdominal exploration revealed a rupture in the right uterine cornua with ongoing slow bleeding, through which a portion of the amniotic sac protruded into the abdominal cavity.

OUTCOMES

The laceration was repaired, the patient and neonate recovered without complications, and were discharged 5 days postoperatively.

LESSONS

An increased awareness of the rare but real possibility of spontaneous uterine rupture in a primigravid patient with no prior uterine scarring helped to establish an earlier diagnosis. Obstetricians should consider this possibility in pregnant females, even in the absence of risk factors and in early gestational age, when sudden unexplained clinical manifestations, such as acute oligohydramnios, are encountered.

Recurrence of a second-trimester uterine rupture in the fundus distant from old scars: A case report and review of the literature

Uterine rupture is a rare event which can have severe obstetric consequences and most often occurs on a scarred uterus at the site of the scar. However, a uterine rupture can appear at another location. We report the case of a woman with a previous emergency caesarean section for spontaneous posterior uterine rupture which recurred at another site during her second pregnancy. She was admitted to the emergency room with acute abdominal pain and development of a pre-shock hemorrhagic state. Abdominal ultrasound showed abundant peritoneal fluid and a fetus without cardiac activity in an intact bulging amniotic fluid membrane. We performed an emergency laparotomy, which confirmed an intact amniotic sac in the abdominal cavity and showed a 7 cm transverse fundal uterine rupture beginning at the right angle, distant from the old known scars. In view of the high maternal and fetal morbidity, obstetricians should have a high suspicion of an antepartum uterine rupture, even at an early gestational age, in the event of acute abdominal pain over a scarred uterus.

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Exceptional case of a second uterine rupture in the second trimester distant from old scars.

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Spontaneous uterine rupture in the second trimester is associated with a higher maternal-fetal morbidity.

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The most common site of spontaneous uterine rupture which did not occur during labor is the fundus.

Spontaneous unscarred uterine rupture and surgical repair at 11 weeks of gestation in a twin pregnancy

A uterine rupture may result in a massive hemoperitoneum, which can be fatal to both the fetus and mother. Most uterine ruptures during pregnancy occur within a scarred uterus, rarely occurring in an unscarred uterus. Here, we report a very rare case of spontaneous rupture in an unscarred uterus at 11 weeks of gestation of a twin pregnancy and its surgical repair. A 37-year-old nulliparous infertile woman became pregnant with twins after artificial insemination and gonadotropin therapy. She underwent emergency surgery at 11 weeks of gestation due to an acute abdomen caused by massive hemoperitoneum. Upon laparotomy, one fetus with placenta was extruded into the abdominal cavity through a 3-cm myometrium rupture on the left posterior wall of the uterus. After surgical repair of the rupture site, the remaining fetus was alive and was successfully delivered by cesarean section at 34 weeks of gestation.

Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis

Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use of different ovarian stimulation protocols and absence of a correct description of the adenomyotic pathology. Current efforts to classify the disease contributed a lot in elucidated the potential characteristics that a classification system should be relied on. The need for a comprehensive, user friendly, and clear categorization of adenomyosis including the pattern, location, histological variants, and the myometrial zone seems to be an urgent need. With the uterus as a possible unifying link between adenomyosis and endometriosis, exploration of the uterus should not only be restricted to the hysteroscopic exploration of the uterine cavity but in a fusion with ultrasound.

Ultrasound diagnosis of endometriosis and adenomyosis: State of the art

Transvaginal ultrasonography has become the primary test in the diagnosis of pelvic endometriosis and adenomyosis. A review of the literature on the diagnostic accuracy of ultrasonography in pelvic endometriosis and adenomyosis, as well as a comparison with magnetic resonance imaging, will be presented. Criteria for diagnosis of an endometrioma according to robust prospective data together with guidelines as to adequate reporting of the location of deep infiltrating endometriosis will be given. The sonographic features of adenomyosis including the differential diagnosis between focal adenomyosis and a uterine fibroid are reviewed. The available data in the literature on ultrasound diagnosis of pelvic endometriosis and adenomyosis, their clinical relevance, and their limitations are discussed.

Obstetrical complications of endometriosis, particularly deep endometriosis

Over the past few years, a new topic in the field of endometriosis has emerged: the potential impact of the disease on pregnancy outcomes. This review aims to summarize in detail the available evidence on the relationship between endometriosis, particularly deep endometriosis (DE), and obstetrical outcomes. Acute complications of DE, such as spontaneous hemoperitoneum, bowel perforation, and uterine rupture, may occur during pregnancy. Although these events represent life-threatening conditions, they are rare and unpredictable. Therefore, the current literature does not support any kind of prophylactic surgery before pregnancy to prevent such complications. Results on the impact of DE on obstetrical outcomes are debatable and characterized by several limitations, including small sample size, lack of adjustment for confounders, lack of adequate control subjects, and other methodologic flaws. For these reasons, it is not possible to draw conclusions on this topic. The strongest evidence shows that DE is associated with higher rates of placenta previa; for other obstetrical outcomes, such as miscarriage, intrauterine growth restriction, preterm birth and hypertensive disorders, results are controversial. Although it is unlikely that surgery of DE may modify the impact of the disease on the course of pregnancy, no study has yet investigated this issue.

Congenital Uterine Anomalies and Uterine Rupture

Congenital uterine anomalies are more common than previously recognized. While many women will have no symptoms or problems, some women with congenital uterine anomalies have increased risks of adverse outcomes during pregnancy. This article presents a case study of a woman with a congenital uterine anomaly leading to spontaneous rupture of her unscarred uterus remote from term. The most common types of congenital uterine anomalies and their associated reproductive risks are reviewed. Evaluation of congenital uterine anomalies and management alternatives are discussed.

Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus

OBJECTIVE

We sought to report obstetric and neonatal characteristics and outcomes following primary uterine rupture in a large contemporary obstetric cohort and to compare outcomes between those with primary uterine rupture vs those with uterine rupture of a scarred uterus.

STUDY DESIGN

This was a retrospective case-control study. Cases were defined as women with uterine rupture of an unscarred uterus. Controls were women with uterine rupture of a scarred uterus. Demographics, labor characteristics, and obstetric, maternal, and neonatal outcomes were compared. Primary rupture case outcomes were also compared by mode of delivery.

RESULTS

There were 126 controls and 20 primary uterine rupture cases. Primary uterine rupture cases had more previous live births than controls (3.6 vs 1.9; P < .001). Cases were more likely to have received oxytocin augmentation (80% vs 37%; P < .001). Vaginal delivery was more common among cases (45% vs 9%; P < .001). Composite maternal morbidity was higher among primary uterine rupture mothers (65% vs 20%; P < .001). Cases had a higher mean estimated blood loss (2644 vs 981 mL; P < .001) and higher rate of blood transfusion (68% vs 17%; P < .001). Women with primary uterine rupture were more likely to undergo hysterectomy (35% vs 2.4%; P < .001). Rates of major composite adverse neonatal neurologic outcomes including intraventricular hemorrhage, periventricular leukomalacia, seizures, and death were higher in cases (40% vs 12%; P = .001). Primary uterine rupture cases delivering vaginally were more likely to ultimately undergo hysterectomy than those delivering by cesarean (63% vs 9%; P = .017).

CONCLUSION

Although rare, primary uterine rupture is particularly morbid. Clinicians must remain vigilant, particularly in the setting of heavy vaginal bleeding and severe pain.

Adenomyosis: a life-cycle approach

The life-cycle approach to endometriosis highlighted unexpected features of the condition; the same approach was therefore applied to gain insight into the clinical features of adenomyosis and to draw a comparison with endometriosis. This is possible today thanks to new imaging techniques enabling non-invasive diagnosis of adenomyosis. The specificity and sensitivity of magnetic resonance imaging and transvaginal ultrasound remain uncertain. Unlike endometriosis, little information is available on the presence of classic adenomyosis in adolescents, except for rare cystic forms that may not represent the true disease. Adenomyosis is most likely to affect adult women, although most reported incidences are still based on post-hysterectomy studies, and are affected by diligence in histopathologic diagnosis and the adopted cut-off point. The traditionally accepted associations of adult adenomyosis, such as multiparity, a link to infertility and its effect on pregnancy are uncertain. Active adenomyosis has been found in pre- and peri-menopausal women and in postmenopausal women receiving tamoxifen. In conclusion, major diagnostic limitations and the systematic bias of hysterectomy make it difficult to draw firm conclusions from existing evidence. In addition, no information is available on the natural history of adenomyosis and no study has systematically evaluated its existence in adolescents.

Spontaneous postpartum rupture of an intact uterus: a case report

Rupture of uterus is an obstetrical complication characterized by a breach in the uterine wall and the overlying serosa. We report an unusual case of spontaneous rupture of an unscarred uterus in a 33-year-old woman, a day after her third successful vaginal delivery. A 33-year-old pregnant woman, gravid 3, para 3, was referred to our department at 39 gestational week because of rupture of membranes. Despite tocolysis administration, her pregnancy was delivered vaginally after 2 days, giving birth to a male neonate of 3,020 g with normal Apgar scores at first and fifth minute. Her uterus was intact and gynecological examination after delivery was normal without any potential signs or symptoms of pathology. However, the day following her labor, patient complained of left iliac fossa pain. Her blood tests revealed a CRP value at 27.6 mg/L, whereas the X-rays revealed an extensive impacted fecal mass in the colon. MRI revealed that the left lower myometrial part of the uterus was depicted abrupt, with simultaneous presence of hemorrhagic stuff. The decision of laparotomy was therefore made in order to further evaluate rupture of uterus and properly treat patient. And subtotal hysterectomy was performed. Postoperative follow-up period was not characterized by any complications and patient was finally discharged 4 days after hysterectomy.