2026 SOAP Annual Meeting

Early Gestational Rupture: A Rare Anesthetic Emergency at 13 Weeks

Chloe Abbott BS, Tyler King MD, Shriram Mahabal MD, John Thomas MD

Department of Anesthesiology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC

Background

Uterine Ruptures are an obstetric emergency.
Around 2.4-3.0 ruptures in every 10,000 deliveries.1
Early-gestation rupture is often overlooked due tononspecific symptoms and low clinical suspicion and as aresult, diagnosis is frequently delayed
Emergency intervention is necessary to prevent life-threatening hemorrhages and improve maternal morbidity.
Emerging literature demonstrates that uterine rupturescan occur as early as 9-11 weeks' gestation.2

Al-Zirqi I, Stray-Pedersen B, Forsén L, Daltveit AK, Vangen S. Uterine rupture: trends over 40 years.BJOG. 2016;123(5):780-787. doi:10.1111/1471-0528.13394
Perdue M, Felder L, Berghella V. First-trimester uterine rupture: a case report and systematic review ofthe literature. American Journal of Obstetrics and Gynecology.2022;227(2):209-217.doi:10.1016/j.ajog.2022.04.035

Case Report

40-year-old female G6P1A5 at 13W + 5D
Presented with acute abdominal pain, hypotension, and tachycardia
Patient h/o:
Low transverse C-section 7m prior
Transabdominal cerclage
Pyelonephritis
On labs: severe anemia, metabolic acidosis, and worsening coagulopathy
Diagnosis:
NCCT: Full-thickness myometrial defect; peri-uterine hematoma and hemoperitoneum
In OR- Emergency exploratory laparotomy that showed a 4-cm uterine rupture
Anesthetic approach:
General anesthesia (sevoflurane); A-line and double lumen CVC
Vasopressors used- Norepinephrine and Phenylephrine
Due to massive blood loss (2L): 7 L crystalloid, 4 units pRBCs, and 1 unit of FFP
Remained intubated postoperatively 2º to metabolic acidosis (extubated POD1)
She recovered without complication and was discharged on POD5

Teaching Points

This case demonstrates that spontaneous uterine rupture can occur in early pregnancy,even following a low transverse cesarean incision and outside the intrapartum period.
Clinical presentation varies widely and occurs at various gestational age.
In a review of 61 early-gestation uterine ruptures, abdominal pain was the mostcommon presenting symptom (97%), followed by vaginal bleeding (23%), syncope(16%), and gastrointestinal symptoms such as nausea and vomiting (7%).
Uterine rupture should remain in the differential diagnosis for pregnant patientsregardless of gestational age especially if they are presenting with
Acute abdominal pain
Hemodynamic instability
Unexplained anemia
Early recognition and prompt surgical intervention are critical to minimizing maternalmorbidity and mortality

Early Gestational Uterine Rupture: A Rare Anesthetic Emergency at 13 Weeks