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Uterine rupture during labor is a life-threatening obstetrical emergency encountered infrequently that can lead to severe prognosis
for the mother and her child if not immediately diagnosed and treated. Most cases occur during labor in parturients with
a scarred uterus. We report the case of a uterine rupture on unscarred uterus occurring in a 40 years old para 2 women during
the labor. The patient presented a history of laparoscopically managed ovarian endometrioma. No prior uterine surgery had been
carried out. The pregnancy was obtained by assisted reproductive treatments (egg donation) and a gestational hypertension appeared
to term, requiring labor induction by intravaginal prostaglandin and intravenous ocytocine injection. At delivery, the patient
presented an acute abdominal pain and hypovolemic shock. Prolonged decelerations then a serious bradycardia appeared at the
cardiotocography. Emergency laparotomy was performed and revealed that the fetus and the placenta were expulsed out of the uterus,
in the abdominal cavity. Massive hemoperitoneum resulting from active bleeding located at the right uterine vessels was found. There
was a lacerated and detached area at the uterine isthmus. A hysterectomy was performed. The patient received blood transfusion and
was fully recovered. The subsequent histology analysis revealed a parietal rupture of the myometrium which was the seat of a diffuse
decidualized adenomyosis. This case focuses on the need to consider decidual change of the stroma within the ectopic endometrium
during pregnancy. Thus, adenomyosis, a common gynecologic disease can affect the course of pregnancy, labor and delivery.
Nohuz E has completed his PhD from Auvergne University, France and Postdoctoral studies from Clermont-Ferrand University School of Medicine, France. He is an expert Surgeon who has a pronounced affinity for Endoscopic Surgery (Laparoscopy and Hysteroscopy). He is the chief of Department of Obstetrics, Gynecology and Surgery at Thiers’s Hospital, France. He has published more than 30 papers in reputed journals and serves as a Reviewer in medical journals of repute.