Massive hemoperitoneum due to rupture of an unscarred uterus diagnosed postpartum: a near-miss maternal death

Abstract

Spontaneous rupture of an unscarred uterus during pregnancy and labor leading to massive hemoperitoneum is a rare occurrence but with significant morbidity to the mother and fetus. Oxytocin use in labour is a known risk factor for rupture of unscarred uterus. A 21-year-old primigravid woman at 39 weeks of gestation with no known risk factors had labor augmented with an oxytocin infusion; she developed tachysystole and delivered vaginally. Two hours postpartum, pallor, abdominal distension, and a dramatic fall in hemoglobin were noted. An abdominal ultrasound revealed a massive amount of free fluid. At emergency laparotomy the hemoperitoneum was confirmed, and rupture of the posterior wall of the uterus was discovered. Repair of the site of rupture, blood transfusion, and intensive care resulted in a satisfactory recovery. When hemoperitoneum develops in the postpartum period, uterine rupture should be strongly suspected, particularly when oxytocin has been utilized during labor. Judicious use of oxytocin, careful monitoring of labour, and high suspicion of uterine rupture when oxytocin is used play vital roles in preventing the disastrous outcome of maternal death.