Spontaneous rupture of the caesarean section scar in the first trimester: Case report

First trimester rupture of uterine scar in pregnancy is an extremely rare event and can confound a clinician. This is especially, if there is an over reliance on diagnostics services without a high index of suspicion. This was a case of a 31 year old, Para 1+0 G2, with one previous caesarian scar who presented to The Nairobi Hospital with acute onset of abdominal pains at 12 weeks of gestation. An ultrasound done showed moderate amount of fluid in the abdominal cavity with an intra-uterine pregnancy. Subsequently a laparoscopic evaluation was done and revealed ruptured uterus through the previous scar. A decision to convert to laparotomy was made, products of conception evacuated, uterine rupture repaired in layers and abdominal cavity closed. The post-operative period was uneventful and the patient was discharged home on third post-operative day. This case report underscores the rarity and the diagnostic challenges of spontaneous rupture of caesarian section scar in the first trimester.