Abstract:

Uterine rupture is a rare and severe obstetric complication, mainly associated with a history of previous cesarean section or other uterine surgeries. This paper reports a case where a patient, who had underwent laparoscopic right salpingectomy and right cornual uterine wedge resection due to cornual pregnancy, became pregnant again only 4 months after surgery. At 32⁺¹ weeks of gestation, she presented with acute abdomen. Due to non-specific symptoms of the patient, mainly manifested as persistent lower abdominal pain accompanied by nausea and vomiting, which overlapped with the symptoms of common acute abdomen conditions in the second and third trimesters of pregnancy such as threatened preterm labor, placental abruption, and acute appendicitis, it was difficult to directly distinguish the condition through clinical manifestations. Additionally, the patient initially only mentioned the history of right salpingectomy and did not clearly state the key surgical information of previous cornual pregnancy and cornual uterine wedge resection, resulting in the failure of early identification of the risk of uterine rupture related to the uterine scar in clinical practice. After bedside ultrasound examination revealed intra-abdominal effusion indicating internal hemorrhage, and after repeated inquiries and a detailed review of the surgical history, the diagnosis of uterine rupture was gradually focused on. Subsequently, an emergency laparotomy was performed, and a live infant was delivered by cesarean section, confirming the diagnosis of uterine rupture.The patient lost 1 200 mL of blood during the operation and recovered well after the surgery. For pregnant women with a history of cornual uterine surgery, the following key points should be emphasized in pregnancy management: strict contraception for 2 years (to allow uterine scar mature), and enhanced ultrasound monitoring in the second and third trimesters of pregnancy (to evaluate the thickness of the scar and the abdominal cavity situation). In clinical diagnosis and treatment, a detailed medical history, especially the history of non-cesarean uterine surgeries, should be obtained. In cases of acute abdomen, ultrasound should be used to check for intra-abdominal hemorrhage and uterine structural abnormalities as a priority. Once the diagnosis is confirmed, emergency surgery should be initiated immediately to reduce maternal and fetal risks.

Key words: Uterine rupture, Pregnancy, Pregnancy, cornual, Ultrasonography, Diagnosis, Case reports