# First-trimester uterine rupture in a scarred uterus: a case report

## TL;DR

This case report highlights the rare but dangerous condition of first-trimester uterine rupture in women with a history of uterine scars.

## Contribution

The paper emphasizes the diagnostic challenges and the need for a high suspicion in identifying early uterine rupture.

## Key findings

- Uterine rupture in the first trimester can be difficult to diagnose due to visible intrauterine gestation on ultrasound.
- Early placenta accreta spectrum should be excluded in patients with uterine scars during first-trimester ultrasonography.
- Clinical signs like hemoperitoneum and instability guide emergency surgical decisions.

## Abstract

First-trimester uterine rupture is a rare but potentially fatal complication of pregnancy. It usually presents a diagnostic challenge because intrauterine gestation may still be visible on ultrasound even after uterine rupture with associated hemoperitoneum. The typical signs of uterine rupture, including abdominal tenderness, hemoperitoneum, and hemodynamic instability, become the guiding principle when considering a decision on emergency laparotomy. In patients with previous uterine scars, first-trimester ultrasonography should focus on excluding early placenta accreta spectrum, a condition that may lead to uterine rupture during the first trimester. A high index of suspicion is required in diagnosing a first-trimester uterine rupture.