Am J Perinatol 2009; 26(10): 739-744
DOI: 10.1055/s-0029-1223287
© Thieme Medical Publishers

Third-Trimester Uterine Rupture without Previous Cesarean: A Case Series and Review of the Literature

Margaret Dow1 , Joseph R. Wax1 , Michael G. Pinette1 , Jacquelyn Blackstone1 , Angelina Cartin1
  • 1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine
Further Information

Publication History

Publication Date:
18 May 2009 (online)


We sought to describe a case series and literature review of uterine rupture in the absence of a previous cesarean delivery. In addition to four cases in our institution, a search of the literature from 1994 to 2008 identified cases of uterine rupture unrelated to a prior cesarean. Uterine rupture in the absence of a previous cesarean may be associated with remote unrecognized uterine perforation, myomectomy, thermal injury, and obstructed labor. Such ruptures may occur before or after labor onset, at term or preterm, and with or without nonreassuring fetal heart rate patterns. Spontaneous uterine rupture is associated with highly variable and nonspecific maternal complaints and fetal status, requiring a high index of diagnostic suspicion.


  • 1 Khan S, Parveen Z, Begum S, Alam I. Uterine rupture: a review of 34 cases at Ayub Teaching Hospital Abbottabad.  J Ayub Med Coll Abbottabad. 2003;  15 50-52
  • 2 Miller D A, Goodwin T M, Gherman R B, Paul R H. Intrapartum rupture of the unscarred uterus.  Obstet Gynecol. 1997;  89 671-673
  • 3 Gardeil F, Daly S, Turner M J. Uterine rupture in pregnancy reviewed.  Eur J Obstet Gynecol Reprod Biol. 1994;  56 107-110
  • 4 Rahman J, Al-Sibai M H, Rahman M S. Rupture of the uterus in labor: a review of 96 cases.  Acta Obstet Gynecol Scand. 1985;  64 311-315
  • 5 Golan A, Sandbank O, Rubin A. Rupture of the pregnant uterus.  Obstet Gynecol. 1980;  56 549-554
  • 6 Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: differences between a scarred and unscarred uterus.  Am J Obstet Gynecol. 2004;  191 425-429
  • 7 Garnet J D. Uterine rupture during pregnancy.  Obstet Gynecol. 1964;  23 898-905
  • 8 Walsh C A, Baxi L V. Rupture of the primigravid uterus: a review of the literature.  Obstet Gynecol Surv. 2007;  62 327-334
  • 9 Gielchinsky Y, Rojansky N, Fasouliotis S J, Ezra Y. Placenta accreta—summary of 10 years: a survey of 310 cases.  Placenta. 2002;  23 210-214
  • 10 Nahum G G. Uterine anomalies: how common are they and what is their distribution among subtypes?.  J Reprod Med. 1998;  43 877-887
  • 11 Samuels T A, Awonuga A. Second trimester rudimentary horn pregnancy: rupture after labor induction with misoprostol.  Obstet Gynecol. 2005;  106 1160-1162
  • 12 Hamilton B E, Martin J A, Sutton P D. National Vital Statistics Reports. Births: Preliminary data for 2003. Available at: Accessed December 17, 2008
  • 13 Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: risk factors and pregnancy outcome.  Am J Obstet Gynecol. 2003;  189 1042-1046
  • 14 Sweeten K M, Graves W K, Athanassiou A. Spontaneous rupture of the unscarred uterus.  Am J Obstet Gynecol. 1995;  172 1851-1856
  • 15 Kaczmarczyk M, Sparen P, Teryy P, Cnattingius S. Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden.  BJOG. 2007;  114 1208-1214
  • 16 Grimes D A, Schulz K F, Cates Jr W J. Prevention of uterine perforation during curettage abortion.  JAMA. 1984;  251 2108-2111
  • 17 Kaali S G, Szigetvari I A, Bartfai G S. The frequency and management of uterine perforations during first-trimester abortions.  Am J Obstet Gynecol. 1989;  161 406-408
  • 18 Cheng P J, Chueh H Y, Soong Y K. Sonographic diagnosis of a uterine defect in a pregnancy at 6 weeks' gestation with a history of curettage.  Ultrasound Obstet Gynecol. 2003;  21 501-503
  • 19 Sentilhes L, Sergent F, Roman H, Verspyck E, Marpeau L. Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy.  Eur J Obstet Gynecol Reprod Biol. 2005;  120 134-138
  • 20 Turner M J. Uterine rupture.  Best Pract Res Clin Obstet Gynaecol. 2002;  16 69-79
  • 21 Bradley L D. Complications in hysteroscopy: prevention, treatment, and legal risk.  Curr Opin Obstet Gynecol. 2002;  14 409-415
  • 22 Dubuisson J B, Fauconnier A, Deffarges J V, Norgaard C H, Kreiker G, Chapron C H. Pregnancy outcome and deliveries following laparoscopic myomectomy.  Hum Reprod. 2000;  15 869-873
  • 23 Hasbargen U, Summerer-Moustaki M, Hillemans P, Schneider J, Kimming P, Hepp H. Uterine dehiscence in a nullipara, diagnosed by MRI, following use of unipolar electrocautery during laparoscopic myomectomy.  Hum Reprod. 2002;  17 2180-2182
  • 24 Pelosi III M A, Pelosi M A. Spontaneous uterine rupture at thirty-three weeks subsequent to previous superficial laparoscopic myomectomy.  Am J Obstet Gynecol. 1997;  177 1547-1549
  • 25 Hockstein S. Spontaneous uterine rupture in the early third trimester after laparoscopically assisted myomectomy. A case report.  J Reprod Med. 2000;  45 139-141
  • 26 Banas T, Klimek M, Fugiel A, Skotniczny K. Spontaneous uterine rupture at 35 weeks' gestation, 3 years after laparoscopic myomectomy, without signs of fetal distress.  J Obstet Gynaecol Res. 2005;  31 527-530
  • 27 Smith J G, Mertz H L, Merrill D C. Identifying risk factors for uterine rupture.  Clin Perinatol. 2008;  35 85-99
  • 28 Ranzini A C, White M, Guzman E R, Scorza W E. Prenatal sonographic diagnosis of uterine rupture following open fetal surgery.  Obstet Gynecol. 1999;  93 826-827
  • 29 El Kady D, Gilbert W M, Xing G, Smith L H. Maternal and neonatal outcomes of assaults during pregnancy.  Obstet Gynecol. 2005;  105 357-363
  • 30 Walsh C A, Baxi L V. Rupture of the primigravid uterus: a review of the literature.  Obstet Gynecol Surv. 2007;  62 327-334
  • 31 Ridgeway J J, Weyrish D L, Benedetti T J. Fetal heart rate changes associated with uterine rupture.  Obstet Gynecol. 2004;  103 506-512
  • 32 Rodriguez M H, Masaki D I, Phelan J P, Diaz F G. Uterine rupture: are intrauterine pressure catheters useful in the diagnosis?.  Am J Obstet Gynecol. 1989;  161 666-669
  • 33 Phelan J P, Korst L M, Settles D K. Uterine activity patterns in uterine rupture: a case-control study.  Obstet Gynecol. 1998;  92 394-397
  • 34 Matsuo K, Scanlon J T, Atlas R O, Kopelman J N. Staircase sign: a newly described uterine contraction pattern seen in rupture of unscarred gravid uterus.  J Obstet Gynaecol Res. 2008;  34 100-104
  • 35 Eden R D, Parker R T, Gall S A. Rupture of the pregnant uterus: a 53-year review.  Obstet Gynecol. 1986;  68 671-674
  • 36 Kieser K E, Baskett T. A 10-year population-based study of uterine rupture.  Obstet Gynecol. 2002;  100 749-753
  • 37 Suner S, Jagminas L, Peipert J F, Linakis J. Fatal spontaneous rupture of a gravid uterus: case report and literature review of uterine rupture.  J Emerg Med. 1996;  14 181-185
  • 38 Kapoor D S, Sanjeev D S, Alfirevic Z. Management of unscarred ruptured uterus.  J Perinat Med. 2003;  31 337-339
  • 39 Usta I M, Hamdi M A, Musa A A, Nassar A H. Pregnancy outcome in patients with previous uterine rupture.  Acta Obstet Gynecol Scand. 2007;  86 172-176

Joseph R WaxM.D. 

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