Posterior Uterine Wall Rupture in a Multiparous Female Presenting Post-Cesarean Deliveries: A Case Report.

Uterine rupture is a rare and one of the most dreaded complications of pregnancy. It carries potentially disastrous consequences for both the mother and the fetus. It occurs frequently during the antepartum or peripartum period. In the majority of cases, the rupture occurs at the lower anterior uterine segment. However, the rupture can rarely occur atypically at the posterior wall and away from the surgical scar. The recognized major risk factors for uterine rupture include previous cesarean deliveries, uterine surgeries, advanced maternal age, and induction of labor with prostaglandins. Our center experienced an unusual case of posterior uterine rupture in a 40-year-old gravid woman, G8P6A1, presenting four hours after cesarean delivery with non-specific clinical presentation of hypotension and paleness. Physical examination revealed no abdominal distension, pain, or tenderness. Blood per-vaginum was not remarkable. The diagnosis was initially made by ultrasonographic findings and was confirmed by exploratory laparotomy. A subtotal hysterectomy was performed. Our case represents an atypical case of uterine rupture with regard to the time of presentation and the clinical features. A high-index of suspicion is therefore necessary for prompt diagnosis and management to prevent non-desirable outcomes.