Background: Occult hemorrhagic shock secondary to uterine rupture represents a true obstetric emergency and\ncan result in significant morbidity and mortality for both the patient and the fetus. Multiparity and prior cesarean\nsections are known risk factors. Typically, these patients present late in gestation, often secondary to the physiologic\nstresses on the uterus related to contractions. This pathology is less common earlier in pregnancy and can often be\noverlooked in the acute setting.\nCase presentation: We present the case of a 31-year-old female with three prior gestations, two parities and two\nprior cesarean sections, resulting in three live births, who presented to the Emergency Department (ED) 22-weeks\npregnant with acute onset dyspnea and an episode of syncope. Due to her altered mental status there was\nconcern for occult shock, despite normal vital signs. Large amounts of free fluid in the abdomen were noted on\nbedside ultrasonography with a high suspicion for uterine pathology. She was resuscitated with blood and taken\nimmediately to the operating room for surgical management where she was found to have had a uterine rupture.\nConclusion: This case highlights a rare presentation of a well-known obstetric emergency, due to the patientâ??s\ndevelopment of uterine rupture early in gestation. Consequently, emergency physicians should consider atraumatic\nhypovolemic shock, secondary to this obstetric catastrophe, even at a stage that far precedes its expected presentation.\nIn addition, we make note of how this case validated our departmentâ??s integrated emergency medicine model, the\nfirst in the State of Israel.
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