Spontaneous second trimester uterine rupture after classical cesarean

Background: Several cases of spontaneous second trimester uterine rupture h ave been reported, but none as early as 15 weeks' gestation after classical cesarean and with placenta percreta. Case: A 23-year-old woman, gravida 5, para 3, at 15 3/7 weeks' gestation wi th a history of classical cesarean incision presented to the emergency depa rtment with abdominal pain, hypotension, and tachycardia. Ultrasound showed a normal intrauterine pregnancy. She developed worsening pain, abdominal r ebound, and abdominal distention. On exploratory laparotomy, a large uterin e rupture was found and hysterectomy was done. Conclusion: Spontaneous uterine rupture after classical cesarean can occur as early as 15 weeks' gestation. Uterine rupture must be considered in diff erential diagnoses of severe abdominal pain even in the early second trimes ter. (Obstet Gynecol 2000;96:806-8. (C) 2000 by The American College of Obs tetricians and Gynecologists.).