Uterine rupture during pregnancy after laparotomic myomectomy

There is a concern about the risk of uterine rupture in the subsequent pregnancy after myomectomy which is reported to be around 0.7-1%. Surgical methods often cause a scar in the myometrium, which may lead to weakening of the muscular wall. As a consequence, it may increase the risk for the obstetric calamity of sudden uterine rupture. In this study, a 39-year-old pregnant woman underwent a laparotomic myomectomy 3 years ago. At 36 weeks of gestation, she was admitted to a tertiary hospital because of severe abdominal pain and suspected uterine rupture. An emergency ultrasound examination showed a complete uterine rupture in the posterior wall of the uterus and a fetus was visualized in the right abdomen without fetal heartbeats. An emergent exploratory laparotomy was performed to repair the wound and save the life of the woman. This is an unusual case of complete uterine rupture following myomectomy that the stillbirth and placenta enclosed by amniotic sac in the right upper abdominal cavity. From this case, we suggest that when the uterine rupture is suspected, the ultrasonologist should carefully observe and accurately detect the rupture of the uterus and the ultrasound plays a very important role in uterine rupture diagnosis after previous scar.