# Spontaneous rupture of a bicornuate uterus at 19 weeks gestation: A case report

## TL;DR

A rare case of spontaneous uterine rupture at 19 weeks is reported in a woman with a bicornuate uterus, highlighting the importance of considering this condition in mid-trimester abdominal pain.

## Contribution

This case report highlights the rare but severe obstetric complication of uterine rupture in a bicornuate uterus during mid-pregnancy.

## Key findings

- Spontaneous uterine rupture occurred at 19 weeks gestation in a woman with a bicornuate uterus.
- Surgical exploration confirmed a ruptured left uterine horn with hemoperitoneum and fetal demise.
- Management included excision of the ruptured horn and repair of the uterine defect.

## Abstract

A bicornuate uterus (BU) is one of the four principal abnormalities resulting from defective embryological development of the Müllerian ducts, associated with increased risks of miscarriage, preterm birth, and malpresentation.

This case report describes a rare instance of spontaneous uterine rupture in a 31-year-old woman with a bicornuate uterus at 19 weeks of gestation. She presented with severe abdominal pain and signs of hypovolemic shock. Ultrasound revealed a single dead fetus, and surgical exploration confirmed uterine rupture with the deceased fetus free in the abdominal cavity and significant hemoperitoneum. The ruptured left uterine horn was excised, and the uterine defect was repaired. The patient's postoperative recovery was uneventful.

A bicornuate uterus is a rare anomaly that can lead to serious obstetric complications at any stage of pregnancy. In our case, despite the absence of prior indications of uterine defects, the condition was identified during an emergency diagnostic laparotomy following the exclusion of other surgical diagnoses. Uterine rupture, often linked to previous cesarean deliveries and uterine anomalies, can manifest as acute abdominal pain, vaginal hemorrhage, and fetal distress.

Uterine rupture should be included in the differential diagnosis for acute abdominal pain in mid-trimester pregnancies, particularly in cases of uterine anomalies.

•Uterine rupture must be a differential diagnosis alongside other emergencies in the first and second trimesters.•A bicornuate uterus raises uterine rupture risk, especially in patients with a cesarean history, increasing incidence.•Initial management involves surgical resection of the ruptured horn after resuscitating the patient’s hemodynamic state.•Hysterectomy is recommended if the patient chooses to terminate her fertility.

Uterine rupture must be a differential diagnosis alongside other emergencies in the first and second trimesters.

A bicornuate uterus raises uterine rupture risk, especially in patients with a cesarean history, increasing incidence.

Initial management involves surgical resection of the ruptured horn after resuscitating the patient’s hemodynamic state.

Hysterectomy is recommended if the patient chooses to terminate her fertility.