Abstract / Summary
Abstract Uterine rupture is an obstetrical emergency, typically classified as either (1) complete when all layers of the uterine wall are separated, or (2) incomplete when the uterine muscle is separated but the visceral peritoneum is intact. This article reports an uncommon and previously undescribed aspect of uterine rupture, namely an incomplete rupture involving the uterine serosa as the initial site of disruption. This observation provides a new perspective on the potential mechanisms of uterine rupture and highlights that the uterine serosa is essential for uterine integrity, with true ruptures starting at the serosa. The proposed hypothesis has meaningful implications, emphasizing careful serosal preservation during surgery, such as adhesiolysis involving the uterine serosa, and restoring ideal serosa approximation with 2 to 3 layers of introflecting sutures during myomectomy. The incomplete uterine rupture described in previous literature is a relatively stable anatomical state that can be managed expectantly in asymptomatic preterm patients.