Spontaneous Fundal Rupture of an Unscarred Uterus at 28 Weeks Gestation in a Multiparous Woman: A Case Report.

BACKGROUND: Spontaneous uterine rupture in an unscarred uterus is an exceedingly rare but life-threatening obstetric emergency associated with substantial maternal and perinatal morbidity and mortality. Prelabor fundal rupture at 28 weeks is particularly unusual because most uterine ruptures occur in previously scarred uteri. CASE PRESENTATION: We report a case of spontaneous fundal rupture in a 36-year-old multiparous woman (G5P4) at 28 weeks of gestation with no previous uterine surgery. The patient presented with sudden severe abdominal pain, progressive abdominal distension, hemodynamic instability, and intrauterine fetal demise. Bedside ultrasound revealed massive hemoperitoneum. Emergency laparotomy confirmed a 4×5 cm fundal rupture with extrusion of fetal and placental contents. The defect was repaired in two layers, followed by intensive multidisciplinary postoperative care. CONCLUSION: Spontaneous rupture of an unscarred uterus should remain in the differential diagnosis of pregnant patients presenting with acute abdominal pain, shock, and hemoperitoneum, even in the absence of previous uterine surgery, because it may mimic placental abruption or other causes of acute abdomen. Prompt recognition, aggressive resuscitation, timely surgical intervention, and coordinated multidisciplinary care are critical to maternal survival.