Silent Uterine Rupture Following Suspected Illegal Abortion and Misoprostol Use: A Case Report

Abstract

Uterine rupture is an uncommon, serious, and potentially life-threatening complication characterized as a disruption of the whole uterine muscle and the visceral peritoneum. Herein, we report a case of silent uterine rupture following illegal abortion via misoprostol administration. A 28-year-old female Gravida 2 Parity 1 living 1 at 18 weeks of gestation with a history of previous cesarean section presented to the hospital. She took 1000 μg of misoprostol tablet 1 day before her admission and due to unsuccessful abortion, presented to the hospital. The evidence of uterine perforation was not identified in the ultrasonography investigation. Following several attempts for abortion using misoprostol, oxytocin, trans-cervical Foley catheter, and dilation and evacuation (D & E) procedures, patients underwent exploratory laparotomy. Uterine rupture was diagnosed during surgery. The uterus was torn, and the fetus and placenta were found in the abdominal cavity with omentum sealing the rupture of the uterus. The fetus and placenta were removed and after proper toileting and controlling of bleeding, the uterus was closed. This case highlights the need for high-quality obstetric care and skilled paramedical and medical staff. It warns that medications such as prostaglandins and oxytocin should be administered only by experts and, lastly, that health facilities should not manage deliveries if they are not equipped well for the complications of delivery and labor. Our case also highlighted the possibility of silent uterine rupture in which the diagnosis is even harder. As a result, in cases where abortion approaches are unsuccessful, health practitioners should think about the possibility of uterine rupture.

References:

[1] Bell SO, Shankar M, Moreau C. Global epidemiology of induced abortion. Oxford Research Encyclopedia of Global Public Health2021.

[2] Hang NT, Vung ND. Knowledge and experiences of abortion among adolescent girls in Asia: a scoping review from 2010 to 2020. Tạp chí Nghiên cứu Y học. 2021;148(12):165-78.

[3] Harris LH, Grossman D. Complications of unsafe and self-managed abortion. New England Journal of Medicine. 2020;382(11):1029-40.

[4] Rashidpouraie R, Dastjerdi MV, Shojaei A, Saeeditehrani S, Sharifi M, Joodaki K, et al. Complications of illegal abortion in the suburbs of Tehran: A 9-year cross-sectional study. J Res Med Sci. 2021;26:89.

[5] Mahmoudiandehkordi S, Yeganegi M, Shomalzadeh M, Ghasemi Y, Kalatehjari M. Enhancing IVF Success: Deep Learning for Accurate Day 3 and Day 5 Embryo Detection from Microscopic Images. International Journal of Applied Data Science in Engineering and Health. 2024 Aug 14;1(1):18-25.

[6] Fogelberg M, Baranov A, Herbst A, Vikhareva O. Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;30(17):2058-61.

[7] Toppenberg KS, Block WA, Jr. Uterine rupture: what family physicians need to know. Am Fam Physician. 2002;66(5):823-8.

[8] Justus Hofmeyr G, Say L, Metin Gülmezoglu A. Systematic review: WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG: An International Journal of Obstetrics & Gynaecology. 2005;112(9):1221-8.

[9] Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, Subtil D. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol. 2014;179:130-4.

[10] Walsh CA, Baxi LV. Rupture of the primigravid uterus: a review of the literature. Obstet Gynecol Surv. 2007;62(5):327-34; quiz 53-4.

[11] Al-Zirqi I, Daltveit AK, Forsén L, Stray-Pedersen B, Vangen S. Risk factors for complete uterine rupture. American journal of obstetrics and gynecology. 2017;216(2):165. e1-. e8.

[12] Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. New England Journal of Medicine. 2001;344(1):38-47.

[13] Nguefack C, Ekane G, Ngoupeyou E, Njamen T, Kamgaing J, Egbe T, Priso E. Uterine rupture in the Douala General Hospital, Cameroon: prevalence, risk factors, management and prognosis. Health Sci Dis. 2016;17(1):1-6.

[14] Ali MK, Botros HA, Mostafa SA. Foley’s catheter balloon for induction of mid-trimester missed abortion with or without traction applied: a randomized controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine. 2020;33(2):198-205.

[15] Desouky E, Elsayed AA. Randomized Controlled Trial Between Vaginal Misoprostol Alone Versus Weighted Intrauterine Foley’s Catheter and Vaginal Misoprostol in Termination of Mid-Trimester Abortion. Evidence Based Women's Health Journal. 2021;11(2):141-5.

[16] Demirezen G, Aslan Çetin B, Aydoğan Mathyk B, Köroğlu N, Yildirim G. Efficiency of the Foley catheter versus the double balloon catheter during the induction of second trimester pregnancy terminations: a randomized controlled trial. Archives of gynecology and obstetrics. 2018;298:881-7.

[17] Bujold E, Blackwell SC, Gauthier RJ. Cervical Ripening With Transcervical Foley Catheter and the Risk of Uterine Rupture. Obstetrics & Gynecology. 2004;103(1):18-23.

[18] Maslovitz S, Lessing JB, Many A. Complications of trans-cervical Foley catheter for labor induction among 1,083 women. Archives of Gynecology and Obstetrics. 2010;281(3):473-7.

[19] Stamilio DM, DeFranco E, Paré E, Odibo AO, Peipert JF, Allsworth JE, et al. Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery. Obstetrics & Gynecology. 2007;110(5):1075-82.
[20] Bujold E, Mehta SH, Bujold C, Gauthier RJ. Interdelivery interval and uterine rupture. American journal of obstetrics and gynecology. 2002;187(5):1199-202.

[21] Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstetrics & Gynecology. 2010;115(5):1003-6.