IMAGE OF THE MONTH Spontaneous Uterine Rupture

A 35-year-old woman had a history of hysteroscopicresection of a uterine septum with uterine perforation. She subsequently conceived and had spontaneous uterine rupture and stillbirth at 26 weeks ’ gestation. Hysterosalpingography showed a marked uterine deficit. In her next pregnancy, the patient was hospitalized at 26 weeks ’ gestation. Imaging by ultrasound and MRI (Figure 1) showed that fundal thickness was 3 mm. At 30 weeks ’ gesta-tion, elective Caesarean section confirmed an 8 cm area of exposed membranes at the uterine fundus (Figure 2). The defect was repaired following delivery. Although spontaneous uterine rupture is rare,1 its occur-rence frequently results in death or damage to the fetus. Most of the few case reports of rupture following operative hysteroscopy2 are related to hysteroscopic metroplasty, with or without perforation. 3 Use of simultaneous laparoscopy or ultrasound may assist surgeons in prevent-ing perforation. Patients considering pregnancy after hysteroscopic metroplasty with perforation should be advised of potential uterine rupture.2 Consent to publish these images was obtained from the patient