Silent spontaneous uterine rupture in a term pregnancy with extrusion of an intact amniotic sac and without maternal and neonatal morbidity and mortality

Background. Uterine rupture in pregnancy is a rare and catastrophic complication with a high incidence of fetal and maternal morbidity and mortality. Silent spontaneous uterine rupture without maternal or neonatal morbidity or mortality is very rare. Case presentation. We describe a case of silent spontaneous uterine rupture diagnosed during a planned cesarean section in a patient at 38+4 weeks’ gestation with two previous cesarean sections. The mother and newborn were discharged three days later in good health and without complications. Conclusions. Worldwide, the frequency of cesarean deliveries has increased in recent decades and uterine rupture is a very rare catastrophic emergency that can have dramatic consequences. Our case report shows that uterine rupture can occur in pregnancy before labour without any signs or symptoms. Despite the uterine rupture with extrusion of the intact amniotic sac, there were no complications for the mother or the foetus. Timely diagnosis is crucial and future research should find more reproducible parameters to objectify the risk of silent uterine rupture and define the timing of delivery of previous cesarean sections requiring a new surgical delivery. All patients with previous cesarean sections should be counselled about the possibility of early delivery by cesarean section.