Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

10 SECOND TRIMESTER SPONTANEOUS UTERINE DEHISCENCE WITH A SCARRED UTERUS: A RARE OBSTETRIC EMERGENCY

Telesha Zabie, MD, PGY 2; Yolanda Paylor, MD Corresponding author: telesha.zabie@lpnt.net

Sovah Health - Danville, Danville, Virginia

mmHg). She received antihypertensive management with labetalol and nifedipine. An urgent bedside ultrasound revealed focal dehiscence of the prior cesarean section scar at the lower uterine segment with bulging of amniotic fluid. A single viable intrauterine gestation was visualized with normal cardiac activity. An emergent low transverse cesarean section was performed under spinal anesthesia. Upon entering the abdomen, the fetal membranes and a fetal foot were immediately visible through the thin uterine wall. Artificial rupture of membranes was performed, and a live male infant was delivered atraumatically using standard breech maneuvers. The uterine tissue appeared friable and challenging to suture, but hemostasis was achieved, and no transfusion was required. The neonate was transferred to the NICU for preterm care, and the patient was discharged on postoperative day two in stable condition. Comments: This case parallels a recent report by Sooknarine et al. (2024), who described a second trimester spontaneous uterine rupture in a multiparous woman with prior cesarean delivery. Both cases underscore that previous uterine surgery remains the primary risk factor. However, unlike the literature case, where diagnosis required MRI confirmation due to inconclusive ultrasound findings, our case was promptly diagnosed using bedside ultrasonography

alone. Both cases required emergent surgical intervention with favorable maternal outcomes, though the present case uniquely demonstrated neonatal survival. Methods: A targeted literature review was conducted using PubMed and Google Scholar with the search terms "spontaneous uterine rupture," "second trimester," "scarred uterus," and "preterm pregnancy." Articles published in English from 2023–2025 were reviewed, focusing on case reports and reviews addressing etiology, clinical presentation, and outcomes of spontaneous rupture in the second trimester. Diagnosis: Second-Trimester Spontaneous Uterine Dehiscence in a Previously Scarred Uterus. Conclusion: This case highlights the diagnostic challenge and clinical urgency of second-trimester uterine dehiscence in a previously scarred uterus. Rapid imaging, a high index of suspicion, and prompt surgical intervention are critical to optimizing both maternal and fetal outcomes. The successful use of ultrasound as the sole diagnostic tool and favorable neonatal survival distinguish this report as a valuable contribution to the limited literature on this rare obstetric emergency.

Background: Uterine rupture is a rare but catastrophic obstetric emergency, typically associated with prior uterine surgery. This condition most commonly occurs in the third trimester or during labor, with earlier presentations being exceptionally rare. The estimated incidence is approximately 0.7 per 10,000 deliveries in unscarred uteri and 5.1 per 10,000 in scarred uteri. When rupture occurs in the second trimester, it is often linked to induced pregnancy terminations in scarred uteri, uterine trauma, or morbidly adherent placentation such as placenta accreta spectrum. True spontaneous rupture or dehiscence before the onset of labor in the second trimester is exceedingly uncommon and can easily be overlooked due to nonspecific presenting symptoms. Report of Case: A 28-year-old G5P2022 woman at 27 weeks gestation, presented to the Labor and Delivery Unit with acute, sharp lower abdominal pain that began the previous afternoon and progressively worsened. She had a history of a recent cesarean delivery nine months earlier. She described intermittent, severe, stabbing pain rated 7/10 at baseline, peaking to 10/10 every few minutes, with no relief after hydration. She denied vaginal bleeding or leakage of fluid and reported normal fetal movement. On admission, she was tachycardic, tachypneic, and hypertensive (182/105

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141 2026 Research Recognition Day