• Xuqing Li, Caihua Li, Meiguo Sun, Hongyan Li, Yunxia Cao, and Zhaolian Wei.
• Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University.
• Medicine (Baltimore). 2021 Jan 22; 100 (3): e24048.

IntroductionUterine rupture during pregnancy is a serious obstetric complication accompanied by a high incidence of maternal morbidity and mortality, and the presence of uterine scars is the main risk factor. In the present case, uterine rupture occurred in an unscarred uterus in a nonlaboring primigravida woman with adenomyosis and twin pregnancy in the third trimester.Patient ConcernsIn this case, the patient suspected to have a history of endometriosis have got twin pregnancies following intracytoplasmic sperm injection, and complained of recurrent lower abdominal pain from 16 weeks to 29 weeks of gestation.DiagnosisAfter exploratory laparotomy, the patient was diagnosed with uterine rupture and adenomyosis.InterventionsThe patient was first administered expectant treatment such as antibiotics, tocolytics, and fluid replacement therapy. Symptoms then appeared repeatedly and worsened, followed by eventual peritoneal irritation, and exploratory laparotomy was performed.OutcomesTwo live female fetuses were extracted by cesarean section, and the uterine laceration was repaired. The mother recovered without any postoperative complications, and the babies were discharged after receiving one month of prematurity care without any postnatal complications.ConclusionAdenomyosis and the conception of twins may lead to uterine rupture. For pregnant women with a history of adenomyosis with multiple gestations, close monitoring for signs of uterine rupture is necessary. Single-embryo transfer and multifetal pregnancy reduction should be recommended for infertile patients with adenomyosis.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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