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[A woman in the second trimester of pregnancy with acute abdominal pain].

A 42-year-old pregnant (22 weeks) woman with a history of peptic ulcer 20 years earlier, was presented to our gynaecological clinic with acute abdominal pain in 2005. She was para-1, had delivered a healthy child two years earlier and now she had an uncomplicated pregnancy. Upon admittance she was pale, hyperventilating and complained of epigastric pain and nausea. There was no vaginal bleeding and no uterine contractions. Ultrasound examination revealed a single fetus with normal cardiac activity. During the examination blood pressure suddenly dropped and the patient was considered to be in a state of pre-shock. Intraabdominal hemorrhage was suspected and she underwent immediate exploratory laparotomy. Uterine rupture with an intact gestational sac extruding through the laceration in the middle of the fundal region of the uterus was found. A sub-total hysterectomy was performed. The physio-pathology leading to the uterine rupture is discussed. An interstitial pregnancy close to the ostium internum (cornual pregnancy) may have lead to the thinning and rupture of the uterine wall in the fundal part. Alternatively, the placenta's location in the upper uterine cavity (possibly caused by a 3 cm myoma that seemed to divide the uterine cavity into two compartments) may have caused thinning and rupture of the uterine wall in the fundal part. The literature describing uterine rupture in the second trimester is reviewed.