Background: Uterine rupture is a rare but fatal complication of pregnancy, which should be diagnosed and treated promptly. Majority of rupture occur during labor in scarred uterus, though very rare, uterine rupture may also occur antepartum.
Case Report: A 32-year-old woman presented with spontaneous antepartum posterior wall uterine rupture with an unknown pregnancy, complaining with abdominal pain and impaired consciousness. At physical examination, she had a firm fullness at abdomen. The ultrasound was inconclusive due to intra-abdominal gas, except for pelvic free fluid, and computed tomography scans showed an intra-abdominal dead fetus. Surgery revealed a wide perforation at the posterior wall of uterus and massive hemoperitoneum, in addition to a dead fetus. The patient underwent hysterectomy due to poor tissue quality and extensive perforation. She made an uneventful recovery and was discharged at the end of 2 week.
Conclusion: Correct clinical history plays a major role in diagnosis. An enlarged uterus in a patient with previous cesarean section should alert the radiologist for uterine rupture. Whenever ultrasound imaging is insufficient to clarify the clinical manifestation, further imaging should be obtained.