Abstract / Summary
Abstract Background Spontaneous rupture of an unscarred uterus is a rare and life-threatening obstetric emergency, particularly when it occurs before the onset of labor and involves the upper uterine segment. Case presentation We report the case of a 33-year-old Yemeni grand multigravida (G7P6) at 38 weeks’ gestation who presented with sudden severe abdominal pain, hypovolemic shock, and intrauterine fetal demise. She had no documented previous cesarean delivery although she had undergone exploratory laparotomy three years earlier for a “missed intrauterine device,” with no operative records available. Emergency laparotomy revealed a localized 4×4 cm rupture in the left upper uterine segment with massive hemoperitoneum. A deliberate lower uterine segment incision was performed to allow controlled fetal delivery and to avoid extension of the rupture. Conservative uterine repair was successfully performed. Conclusion This case highlights the diagnostic challenge of silent uterine rupture in an apparently unscarred uterus and demonstrates that strategic surgical decision-making can facilitate uterine preservation in selected cases, even in resource-limited settings.