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EXTRAUTERINE PREGNANCY RESULTING FROM EARLY UTERINE RUPTURE

Marcus, Sarah MD; Cheng, Edith MD; Goff, Barbara MD

Obstetrics

Background: Cesarean scar rupture of a gravid uterus in early gestation is rare.

Case: A 38-year-old woman, gravida 4, para 2-0-1-1, presented at 13 weeks' gestation with cramping and spotting. She had a history of two cesareans. Ultrasound and magnetic resonance imaging indicated probable uterine dehiscence and a viable extrauterine pregnancy. After embolization of the uterine arteries with subsequent fetal death, the subject had a hysterectomy. Intraoperatively, she had complete rupture of the lower uterine segment, but the pregnancy was enclosed within scar tissue between the uterus and bladder. Placenta percreta was found by histologic examination.

Conclusion: Women with histories of cesareans might be at risk of early uterine rupture.

Prior cesarean is the highest risk factor associated with spontaneous uterine rupture during subsequent pregnancy, and risk increases with more than one cesarean.1,2 Most ruptures occur in late pregnancy and during labor, but there are reports of early ruptures of gravid uteri.3–7 We searched MEDLINE for “early uterine rupture” from 1966–1999 and found seven reports. All were at 15 weeks' gestation or earlier and did not include cornual ectopic pregnancies. We report an eighth case of uterine rupture at 13 weeks' gestation in a woman who had two prior low transverse cesareans.

Extrauterine pregnancy might result from early rupture of a cesarean scar.

Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, Washington.

Sarah Marcus, MD, Department of Obstetrics and Gynecology, University of Washington Medical Center, Box 356460, Seattle, WA 98195-6460; E-mail: smarcus@u.washington.edu

Received February 26, 1999. Received in revised form July 2, 1999. Accepted July 22, 1999.

© 1999 The American College of Obstetricians and Gynecologists