Mrs . A , 27 yr old woman referred from CHC, Zaheeraabaad to our hospital MGMH, Petlaburz, Hyderabad on 23.09.2020 at 4:30 a.m in view of G2 P1L1 with 1 previous LSCS with term gestation, severe preeclampsia and thrombocytopenia of 84,000.

on reaching here , she had a convulsion , her BP was 160/110 .PR 86/min . She was started on MgSO4 regimen .She had extensive pedal oedema Obstetric examination revealed a term gestation per abdomen ,a constriction-ring at the level of umbilicus , the part of uterus above the umbilicus deviated to right ,part below the umbilicus moved to left and it had a boggy feel , per vaginum Cervix effaced and Os dilated to 3 cm , presenting part brow .

USG examination confirmed a rupture uterus with a live foetus .she was taken up for immediate laparotomy . A general anaesthesia was given . Intraoperative findings were consistent with the scan findings . The previous scar had given away along with the bladder that was adherent to it .A live male foetus 2.5 kg was delivered by Patwardhan technique . The lower flap of the uterine scar could not be identified as the entire tissue was oedematous . Bladder integrity checked by retrograde filling . The rent in the bladder dome was identified and urologist called for . The bladder was adherent on the posterior surface to the lower segment, which was dissected and bladder repaired in 2 layers . Uterus lower segmented inspected for extension of any tears , colporrhexis was ruled out and uterine scar sutured . A suprapubic catheter , per urethral catheter and abdominal drain were kept .She was stable throughout the procedure, received 2 packed cell transfusions intra- operatively .MgSO4 regimen continued for 24 hours and thromboprophylaxis , Piptaz cover were given .she is doing well now and happy with her baby .