Case Series: Uterine Rupture with a Life Baby after Two Previous Caesarean Sections: An Incidental Finding at Elective Caesarean Sections at Term

Abstract

We present three cases of the absence of lower uterine segment (LUS) muscles with a life baby covered by the fetal membrane after two previous caesarean sections (CS) at elective CSs at term. The first case was a 30‑year‑old booked multipara with bad obstetrics history andu two previous CS at a secondary facility on account of unexplained three serial stillbirths at term. There were no histories of maternal obesity, hypertension, or diabetes mellitus. She then had an elective CS at 37 weeks on account of two previous CS. Intraoperatively, it was noted that the LUS was covered by the fetal membranes with visceral peritoneum and no muscle layer. The second case was a 33‑year‑old booked G4P2 + 1A2 with two previous CSs on account of fetal distress and breech presentation with one previous scar at term, respectively. Pregnancy was uneventful till the presentation. At presentation, there was no history or examination finding suggestive of uterine rupture. She had an elective CS at 39 weeks on account of two previous CS. Intraoperatively, a thin membrane at the LUS with no muscular tissue exposing the fetal membranes was seen, with good fetomaternal outcomes. The third case was a 30‑year‑old booked G3P2 + 0A2 with two previous elective CSs on account of primigravida with breech presentation and placenta praevia, respectively. The course of the pregnancy was uneventful. At presentation, there was no clinical sign or symptom suggestive of uterine rupture. She had an elective CS at 37 weeks on account of two previous CS. Intraoperatively, a thin membrane at the LUS with visceral peritoneum and no muscular tissue was seen. The pregnancy outcome was favorable. Silent scar rupture as seen in our case series is one of the common  complications of previous CS. Early detection with the introduction of imaging techniques, although not done for our cases and prompt intervention reduces morbidity and mortality.