Abstract:

Uterine rupture is a severe obstetric complication that poses a significant threat to maternal and fetal life. We report a case of a dichorionic twin pregnancy complicated by spontaneous uterine rupture in the third trimester. The patient had undergone high-intensity focused ultrasound (HIFU) treatment for adenomyosis and conceived via in vitro fertilization-embryo transfer one year after the procedure. She presented with acute lower abdominal pain in the third trimester. Ultrasound examination revealed intrauterine fetal demise of one twin and fetal distress in the other, necessitating an emergency cesarean section. Uterine rupture was confirmed intraoperatively. The delivered newborn had a weak heartbeat and succumbed despite active resuscitation. In conjunction with a review of five similar cases reported in the literature, we propose that the occurrence of uterine rupture during pregnancy following HIFU treatment may be associated with factors such as the size and location of the uterine fibroids or adenomyotic lesions, treatment energy parameters and exposure duration, and the interval between HIFU treatment and conception. Given the non-specific clinical presentation of this condition, clinicians should maintain a high index of suspicion for uterine rupture in patients presenting with abdominal pain in the second or third trimester, conduct a detailed medical history, and closely monitor fetal heart rate changes to facilitate early recognition.

Key words: High-intensity focused ultrasound, Pregnancy trimester, third, Uterine rupture, Adenomyosis, Leiomyoma