Spontaneous rupture of uterus.

Spontaneous rupture of the uterus is a life-threatening obstetrical emergency. Diagnosis may be delayed because of the bizarre presentation or absence of significant pain and tenderness, which could have been masked by the analgesic medications used during labor. We present a case of spontaneous rupture in a multigravid female who was undergoing oxytocin-augmented labor while receiving epidural analgesia. She had had no previous cesarean deliveries or uterine surgery. Half an hour after an initial complaint of left inguinal pain, which was thought to be related to a patchy epidural block, she presented with changes in vital signs and significant fetal decelerations. At emergent cesarean section, a uterine rupture was noted. The uterine rupture extended down to the left vaginal angle, was not reparable and a hysterectomy was performed. The fetus survived.