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An Unusual Presentation of Rupture in an Unscarred Uterus

Shilla Mariah Yussof

It is well-known that uterine rupture is an obstetric catastrophe associated with previous scarring, with an incidence of 1 in 200 in those undergoing vaginal birth after caesarian delivery (VBAC) [1]. Little is known though about its occurrence in an unscarred uterus.

In this age of modern obstetric practice, the previously recognized risk factors have become obsolete with the increased utilization of caesarian sections. Prolonged or neglected labours are rarely allowed with the introduction of the partogram. Fetal macrosomia and malpresentation would have been detected antenatally by the utilization of ultrasounds. Breech babies are now delivered by caesarian sections since the publication of the Term Breech Trial [2], and the rate of instrumental deliveries has decreased over the years due to a reduction in training hours, lack of senior supervision and fear of litigation [3]. Nevertheless, modern obstetrics also has its pitfalls. Induction and augmentation of labour play a big part in modern obstetric management and have been shown to predispose to uterine rupture [4-6]. Other non-iatrogenic risk factors include advanced maternal age, multiparity, uterine anomalies and maternal connective tissue disease [7].