We describe a rare case report of unscarred uterus rupture (UR) diagnosed in the puerperium after a vacuum extraction (VE) delivery of a healthy newborn. In this instance, no risk factors were found apart from the use of VE in the setting of prolonged deceleration. The suspicion of the diagnosis was made because of the patient's constant distressing abdominal pain with peritoneal signs as well as a drop in haemoglobin. In the exploratory laparotomy, a 2000 ml haemoperitoneum and a complete transverse tear of the uterine fundus 10 cm long was found in a structurally normal uterus. Peritoneal lavage was effected and the tear was repaired. A very high index of suspicion is needed and the longer the delay in making the diagnosis, and starting treatment, the greater the clinical risk. Since the risk of UR in subsequent pregnancies is very high, caesarean delivery is recommended in any future pregnancy, after fetal pulmonary maturity is confirmed.
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