Spontaneous uterine rupture during pregnancy after radiofrequency ablation for adenomyosis: A case report and literature review

OBJECTIVE: To describe a rare case of spontaneous complete uterine rupture in a primigravida during pregnancy following a prior laparoscopic radiofrequency ablation (RFA) for adenomyosis, and to review pregnancy outcomes after RFA for adenomyosis or uterine fibroids. CASE REPORT: A 30-year-old primigravida at 33 + 4 weeks of gestation, with a history of RFA for adenomyosis, presented to the emergency department with hypovolemic shock. She experienced sudden-onset vaginal bleeding and severe lower abdominal pain, followed by rapid loss of consciousness. Emergency laparotomy revealed massive hemoperitoneum and a longitudinal posterior uterine rupture extending from the fundus to the lower uterine segment, with complete expulsion of the fetus and placenta into the peritoneal cavity. Following delivery of an asphyxiated male infant, the uterus was repaired concurrently with resuscitation and massive blood transfusion, restoring maternal hemodynamic stability. CONCLUSION: RFA for adenomyosis may compromise myometrial integrity and increase the risk of uterine rupture in subsequent pregnancies. Clinicians should provide thorough counseling and close antenatal surveillance for women conceiving after RFA.