{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T16:25:33Z","timestamp":1778516733062,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Case Rep"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Self-managed second-trimester medical abortion has become increasingly common, especially where access to clinical services is limited. Although misoprostol is generally safe when used in evidence-based regimens, unsupervised or excessive dosing can lead to severe complications. Uterine rupture is a rare, life-threatening event that typically occurs in laboring women with prior uterine surgery. We report a case of spontaneous rupture of an apparently unscarred uterus at 22\u2009weeks gestation following unsupervised misoprostol use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation:<\/jats:title>\n                    <jats:p>A 30-year-old G3P2 woman at ~22\u2009weeks presented with abdominal pain and scant bleeding after self-administering misoprostol (total 3000\u2009\u00b5g over 48\u2009hours) for abortion. She had 2 prior uncomplicated vaginal deliveries and no uterine surgery. Clinical evaluation and bedside ultrasound revealed an intact intrauterine fetus with free fluid consistent with hemoperitoneum. Hemodynamic instability prompted urgent laparotomy. Intraoperatively, a 5-cm full-thickness transverse rupture of the anterior lower uterine segment with necrotic edges was found, with the demized fetus in the peritoneal cavity. After debridement, the uterine defect was repaired in 3 layers; hysterectomy was averted. Two units of blood were transfused; broad-spectrum antibiotics and thromboprophylaxis were given.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management and Outcome:<\/jats:title>\n                    <jats:p>Postoperative recovery was uneventful. The patient stabilized, completed antibiotics, and was discharged on day 5 with a progestin implant for contraception. At 6-week follow-up, she was asymptomatic and imaging showed a healed uterine repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case explicitly shows that unsupervised high-dose misoprostol regimens can precipitate catastrophic uterine rupture even in an unscarred, mid-trimester uterus. Early recognition and prompt surgical management allowed uterine preservation. Clinicians should maintain a high index of suspicion for rupture in women presenting with pain and intra-abdominal bleeding after self-managed abortion. This case tries to emphasize the need for safe abortion access, patient education on proper dosing, and post-abortion follow-up with contraception counseling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11795476251412079","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T05:06:03Z","timestamp":1767416763000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Second-Trimester Uterine Rupture in an Unscarred Uterus Following Self-Administered Misoprostol: A Case Report and Literature Review"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4647-111X","authenticated-orcid":false,"given":"Biruk T.","family":"Mengistie","sequence":"first","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0061-6458","authenticated-orcid":false,"given":"Chernet T.","family":"Mengistie","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selam D.","family":"Temesgen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bethel A.","family":"Awoke","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kebron W.","family":"Aweke","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esubalew B.","family":"Belete","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.29245"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13669-023-00354-x"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2019.305369"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2015.01.005"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003017"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.4103\/jpgm.JPGM_19_19"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2024.110740"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12103532"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13579"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0253957"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17517"},{"key":"e_1_3_3_13_2","article-title":"Uterine rupture in a gravid, unscarred uterus: a case report","volume":"24","author":"Halassy SD","year":"2019","unstructured":"Halassy SD, Eastwood J, Prezzato J. Uterine rupture in a gravid, unscarred uterus: a case report. Case Rep Womens Health. 2019;24:e00154.","journal-title":"Case Rep Womens Health"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2024.09.010"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005259"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31794-4"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjaf233"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0249529"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.3389\/fgwh.2025.1478797"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0087-7"}],"container-title":["Clinical Medicine Insights: Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476251412079","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11795476251412079","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476251412079","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:14:51Z","timestamp":1777454091000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11795476251412079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":19,"alternative-id":["10.1177\/11795476251412079"],"URL":"https:\/\/doi.org\/10.1177\/11795476251412079","relation":{},"ISSN":["1179-5476","1179-5476"],"issn-type":[{"value":"1179-5476","type":"print"},{"value":"1179-5476","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"11795476251412079"}}