{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:25:47Z","timestamp":1781007947967,"version":"3.54.1"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Spontaneous uterine rupture is a rare, life\u2010threatening condition typically seen in gravid women with a history of uterine surgery or trauma. This report presents an unusual case of spontaneous uterine rupture in a 29\u2010year\u2010old virgin, highlighting the critical importance of early diagnosis and intervention, even in the absence of typical risk factors. A 29\u2010year\u2010old nulliparous woman presented with acute onset of severe lower abdominal pain during menstruation. She had no history of sexual activity, uterine surgery, or trauma. A high index of suspicion for spontaneous uterine rupture was raised following a computed tomography (CT) scan. An emergent exploratory laparotomy revealed a rupture at the uterine fundus with extensive necrosis, necessitating a total hysterectomy. Histopathological examination confirmed adenomyosis with significant hemorrhage and vascular thrombosis, without evidence of infection or malignancy. Subsequent investigations identified protein\u2010S deficiency, which may have contributed to a hypercoagulable state. This combination of factors led to localized ischemia and structural compromise of the uterine wall, ultimately leading to spontaneous rupture. This case underscores the importance of considering spontaneous uterine rupture in the differential diagnosis of acute abdominal pain in women, regardless of conventional risk factors. The coexistence of adenomyosis and protein\u2010S deficiency might have synergistically contributed to uterine wall compromise and rupture. Early recognition and prompt intervention are essential to prevent severe complications, and evaluation for underlying coagulopathies should be considered to guide management and reduce the risk of adverse outcomes.<\/jats:p>","DOI":"10.1002\/ijgo.70300","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T08:28:48Z","timestamp":1750321728000},"page":"1162-1167","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Life\u2010threatening spontaneous uterine rupture in a non\u2010gravid, unscarred uterus of a nulliparous woman: A case report"],"prefix":"10.1002","volume":"171","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2518-6473","authenticated-orcid":false,"given":"Wan\u2010Ling","family":"Hsieh","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Chi Mei Medical Center  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsun\u2010Wen","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Chi Mei Medical Center  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang\u2010Yao","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Pathology Chi Mei Medical Center  Tainan Taiwan"},{"name":"School of Medicine, College of Medicine National Sun Yat\u2010sen University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6757-4338","authenticated-orcid":false,"given":"Yung\u2010Chieh","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Chi Mei Medical Center  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.10.017"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17517"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.09.874"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02136.x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/01443615.2012.754415"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2016.01.024"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01541-1"},{"key":"e_1_2_11_9_1","first-page":"2936","article-title":"Acute hemorrhage related to spontaneous rupture of an uterine fibroid: a rare case report","volume":"392","author":"Bastu E","year":"2013","journal-title":"Eur J Gynaec Oncol"},{"key":"e_1_2_11_10_1","first-page":"86","article-title":"Spontaneous uterine rupture due to uterine leiomyosarcoma","volume":"24","author":"Boussouni K","year":"2016","journal-title":"Pan Afr Med J"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/13625187.2017.1412427"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v11.i32.7888"},{"issue":"6","key":"e_1_2_11_13_1","first-page":"e114","article-title":"Spontaneous uterine rupture secondary to recurrent haematometra from cervical stenosis","volume":"53","author":"Yang L","year":"2012","journal-title":"Singapore Med J"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-008895"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOH.0000000000000663"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.52403\/ijhsr.20211112"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci12101410"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.07.499"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jeud.2023.100019"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12030842"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.3892\/wasj.2022.162"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03344054"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/10760296211033908"}],"container-title":["International Journal of Gynecology &amp; 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