Missed uterine rupture after vaginal delivery: a rare case of delayed diagnosis leading to sepsis and intra-abdominal abscess

TL;DR

A rare case of silent uterine rupture after vaginal delivery led to sepsis and abscess, highlighting the need for improved diagnostic awareness.

Contribution

Presents a rare clinical case of delayed uterine rupture diagnosis after vaginal delivery.

Findings

Uterine rupture occurred silently after an uneventful vaginal delivery.

Delayed diagnosis resulted in sepsis and intra-abdominal abscess.

Urgent surgery preserved maternal health but resulted in fetal loss.

Abstract

Uterine rupture during pregnancy is a rare but life-threatening complication that poses severe risks to both mother and fetus. While it is typically associated with a history of uterine surgery, its silent presentation post-vaginal delivery remains exceptionally uncommon and diagnostically challenging. We present an extraordinary case of a 30-year-old multigravida at 33 + 2 weeks gestation, who developed a silent uterine rupture days after an uneventful vaginal delivery. The condition was masked by atypical symptoms, leading to delayed diagnosis, prolonged sepsis, and an intra-abdominal abscess. Despite the absence of classical warning signs, the rupture necessitated urgent surgical intervention, ultimately preserving maternal health and uterine integrity with loss of the fetus. This case underscores the critical need for heightened clinical suspicion and advanced imaging techniques in managing post-delivery complications, especially in patients with a scarred uterus.

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