Uterine Rupture in Unscarred Uterus - An Obstetrician's Nightmare

Unscarred uterine rupture is rare and disastrous situation for the mother and the foetus. It has been reported in each trimester of pregnancy and its presentation varies from silent uterine rupture to haemorrhagic shock. It may occur in prelabour stage, second stage or even in fourth stage of labour causing uncontrolled postpartum haemorrhage. Here, we report 2 cases of unscarred uterine rupture during labour. First case was of gravida 4, para 3 who came in shock following the attempt of forceps application during second stage of labour. Laparotomy revealed uterine rupture. Second case was of a primigravida who had cessation of uterine contraction after applying fundal pressure. Clinically, she was diagnosed with rupture uterus that was confirmed on laparotomy with delivery of still born baby. Both these cases were survived as a result of timely diagnosis and immediate laparotomy. Both of them received multiple blood transfusions and discharged in satisfactory condition. This case series tells us that high index of suspicion of an unscarred uterine rupture should be kept in mind irrespective of trimester or phase of labour. Immediate action must be taken to prevent major maternal and foetal morbidity.