First Trimester Uterine Rupture: A Case Report and Literature Review

Int J Environ Res Public Health. 2020 Apr 24;17(8):2976. doi: 10.3390/ijerph17082976.


The aim is to report a case of spontaneous uterine rupture in the first trimester of pregnancy and to review the literature on the topic.

Methods: A literature search was performed using PubMed and Scopus. Relevant English articles were identified without any time or study limitations. The data were aggregated, and a summary statistic was calculated.

Results: A 35-year-old gravida 5, para 2 was admitted at our department because of fainting and abdominal pain. The woman had a first-trimester twin pregnancy and a history of two previous cesarean sections (CSs). Suspecting a uterine rupture, an emergency laparotomy was performed. The two sacs were completely removed, and the uterine rupture site was closed with a double-layer suture. The patient was discharged from hospital four days later in good condition. On the basis of this experience, a total of 76 case reports were extracted from PubMed and included in the review. Fifty-three patients out of 76 (69.74%) underwent previous surgery on the uterus. Most women (67.92%) had a CS, and in this group a cesarean scar pregnancy (CSP) or a placenta accreta spectrum (PAS) disorder was found to be the etiology in 77.78% of cases. Furthermore, 35.85% of the women had hysterectomy after uterine rupture. Twenty-three patients out of 76 (30.26%) had an unscarred uterus. Of this group, most women presented a uterine anomaly (43.48%). Moreover, 17.39% of these women had a hysterectomy.

Conclusion: According to the literature, the current pandemic use of CS explains most cases of first-trimester uterine rupture.

Keywords: cesarean section; first trimester; uterine rupture.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Cesarean Section
  • Female
  • Humans
  • Placenta Accreta*
  • Pregnancy
  • Pregnancy Trimester, First
  • Pregnancy Trimester, Second
  • Uterine Rupture* / etiology