Spontaneous Rupture of an Unscarred Uterus during Induction of Labour after Failed Operative Vaginal Delivery: A Case Report

Abstract

Background: Uterine rupture is a rare but life-threatening obstetric emergency characterized by complete separation of the uterine wall, with risk factors including uterine scarring, trauma, multiparity, obstructed labour, and excessive use of uterotonic agents. Aim: Uterine rupture in an unscarred uterus is a rare, life-threatening obstetric emergency with substantial maternal and neonatal morbidity and mortality. Presentation of Case: We report a 32-year-old multiparous woman (G6P3A2) at 38 weeks undergoing induction of labour for pregnancy-induced hypertension. She had three previous normal vaginal deliveries, a BMI of 40 kg/m², and no prior uterine surgery. Baseline assessment was stable, with normal investigations, reassuring cardiotocography, and a singleton cephalic fetus with estimated fetal weight appropriate for gestational age. Discussion: Induction of labour was initiated with a Foley catheter followed by prostaglandin gel. After spontaneous rupture of membranes, labour progressed rapidly, followed by sudden severe abdominal pain, continuous pushing, and acute fetal bradycardia. Vacuum-assisted delivery for fetal distress failed, and an emergency caesarean section was performed. Intraoperatively, hemoperitoneum and rupture of an unscarred uterus were found, with the fetal hand protruding through the tear and the fetus partially in the abdominal cavity. A live female infant with severe birth asphyxia required advanced resuscitation and neonatal intensive care unit (NICU) admission. The uterine tear was repaired, and the uterus was preserved. Conclusion: This case highlights the importance of considering uterine rupture even in an unscarred uterus, particularly during induction of labour in multiparous women.