Uterine rupture in the second trimester with fetal demise

Uterine rupture can occur in labour or spontaneously, but it is more common in a scarred uterus after a previous lower segment or classical caesarean section, open myomectomy or operative hysteroscopy for a congenital abnormality. The authors present the case of a multiparous woman (Gravida 10, para 5⁺⁴) in her early 30s presenting with abdominal pain and vaginal bleeding at 22⁺⁶ weeks of gestation. She was booked for high-risk antenatal care due to her history of preterm deliveries and a previous classical caesarean section at 25⁺⁶ weeks of gestation. She was diagnosed with a fetal intrauterine death and a uterine rupture. She became haemodynamically unstable and developed disseminated intravascular coagulopathy. A laparotomy was performed. Intraoperatively, there was evidence of complete uterine rupture through the classical incision. The blood loss was 5.5 L. This case illustrates how the physical reserve of a young healthy woman may mask serious intra-abdominal pathology until she begins to decompensate, which is inevitably a late sign.