Three cases of antenatal/pre-labour uterine rupture in women with scarred uterus.

Rupture uterus following lower segment caesarean section is rare occurrence.

Rupture uterus is linked with abnormal implantation of the placenta, and endometrial deficiency. In 10% there’s invasive placentation where placenta invades to deeper layers increasing the risks of bleeding; prematurity; SB/NND; hysterectomy and ICU admission.

1. 34 yrs G5P3 (Cs × 2, SVD × 1, 1 miscarriage) admitted with pain and fainting at 25/40, deteriorated so needed Laparotomy, at surgery, large haemoperitoneum; left sided (5 × 8 cm) uterine rupture, male baby delivered by classical Caesarean died immediately, unable to stop bleeding so subtotal hysterectomy performed, had blood transfusion and admitted to ITU. Histology placenta percreta...

2. 27 yrs G3P1 (Cs × 1, ×1 STOP) known bicornuate uterus, anterior low lying placenta, admitted with massive APH at 29/40 needing emergency classical Caesarean, at surgery there was left sided (10 × 8 cm defect) uterine rupture, found haemoperitoneum, female fetus good condition died later. Uterus re-constructed; bleeding managed with Rusch balloon, medicines, blood transfusion. HDU care. Histology placenta Increta.

3. 39 yrs G6P3 (×3 Cs, miscarriage, 1 Top) known posterior placenta praevia, cerclage insitu, admitted with APH and fetal distress at 33/40, emergency Caesarean, uterine rupture and placenta accreta. Baby boy good condition PPH; failed conservative management; needed subtotal hysterectomy, blood transfusion and ITU Admission. Histology Placenta accrete.

Maternal and fetal morbidity and mortality from abnormal placentation could be catastrophic. Early uterine rupture is challenging diagnosis, because initial signs/symptoms are nonspecific and this delay definitive treatment.