BACKGROUND: Clinically silent uterine rupture with complete fetal expulsion into the abdominal cavity is an extremely rare complication. Diagnosis can be difficult and the risk to the mother and fetus is high. Conservative management has been described only in a few cases of partial expulsion of the fetus so far. CASE PRESENTATION: We present a case of 43-year-old tercigravida with a history of previous laparotomic myomectomy and subsequent cesarean section. The subsequent pregnancy was complicated by uterine wall loosening and rupture at the site of the previous uterine scar after myomectomy and complete fetal expulsion into the abdominal cavity. The diagnosis was made at 24 + 6 weeks of gestation. Considering the absence of clinical symptomatology and the good condition of the fetus, a conservative approach was chosen with intensive monitoring of the maternal and fetal conditions. The pregnancy ended by elective cesarean section and hysterectomy at 28 + 0 weeks of gestation. The postpartum course was uneventful and the newborn was discharged to home care 63 days after delivery. CONCLUSIONS: Fetal expulsion into the abdominal cavity after silent uterine rupture of the scarred uterus may be accompanied by minimal symptomatology making early diagnosis difficult. This rare complication must be considered in the differential diagnosis in women after major uterine surgery. In selected cases and under conditions of intensive maternal and fetal monitoring, conservative management may be chosen to reduce the risks associated with prematurity.

Department of Anesthesiology and Intensive Care University Hospital Brno and Medical Faculty Masaryk University Brno Czech Republic

Department of Health Sciences Faculty of Medicine Masaryk University Brno Czech Republic

Department of Neonatology University Hospital Brno and Medical Faculty Masaryk University Brno Czech Republic

Department of Obstetrics and Gynecology University Hospital Brno and Medical Faculty Masaryk University Jihlavská 20 Brno 625 00 Czech Republic

Department of Pathology University Hospital Brno and Medical Faculty Masaryk University Brno Czech Republic

Department of Pediatric Radiology University Hospital Brno and Medical Faculty Masaryk University Brno Czech Republic

BMC Pregnancy Childbirth. 2023 Jul 22;23(1):533. doi: 10.1186/s12884-023-05853-6. PubMed

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Correction: Conservative management of complete fetal expulsion into the abdominal cavity after silent uterine rupture-case report