“Showercap” Sign: Spontaneous Uterine Rupture in a Primiparous Woman

A 32-year-old primiparous woman presented with severe abdominal pain at 21 weeks’ gestation. Background history of laparoscopy for chronic pelvic pain and a spontaneous miscarriage was noted. On examination, she was peritonitic and tachycardic with low grade fever and anemia. MRI abdomen demonstrated a uterine rupture with a large cap of clotted blood overlying the uterine fundus with the appearance of a “shower cap” and large volume haemoperitoneum, the presumptive diagnosis was uterine rupture with placental extrusion. Emergency laparotomy confirmed a two litre haemoperitoneum due to a 3cm defect at the uterine fundus through which a portion of placenta and membrane were extruding. Hysterotomy and delivery of the non-viable fetus was performed. The defect was repaired. It is important to remember that there are many causes of acute abdominal pain in pregnant patients, obstetric and other. Uterine rupture is a rare but life-threatening cause. An underlying risk factor is usually identified.