Uterine rupture (UR) is a full-thick ness tear of the uterus [1] . Risk factors for uterine rupture during pregnancy include a history of cesarean section, myomectomy with uterine cavity breach, multiparity, uterine malformations, mechanical dystocia, excessive use of uterotonics, and uterine expressions. It is one of the direct obstetric causes of maternal mortality, especially in developing countries [2] . Among spontaneous uterine ruptures, only 17% occur before the onset of labor [3] [4] . However, its incidence in the 1^st and 2^nd trimester of pregnancy is low [4] . Its clinical diagnosis is difficult to establish in the 1^st trimester of pregnancy. Ultrasound, when available, allows for the visualization of hemoperitoneum and uterine breach. We report a case of spontaneous uterine rupture in a pregnancy of 12 weeks’ amenorrhea in a woman with a history of three times scarred uterus in a context of short inter-genesis space of thirteen months.

Uterine rupture is a non-surgical continuity solution of the uterine wall that can occur during pregnancy or labor [5] [6] . It has become exceptional in developed countries with a prevalence of 0.5/10000 to 7.9/10000 births [7] but remains prevalent in under-medicalized countries with the inflation of cesarean rates over the past 20 years. The scarred uterus is a major risk factor for uterine rupture. In developed countries, its share among uterine ruptures varies between 70% and 90% [8] . In the present clinical case, the patient had a history of three uterine scars for cesarean section. The occurrence of uterine rupture could be explained by this state of fragility of the uterus induced by multiple uterine scars. The type of uterine incision is the main factor increasing the risk of uterine rupture, with the risk being higher in the case of corporal incision compared to a low transverse segmental incision [9] [10] . In the present clinical case, the operative protocols of the different cesarean sections were not available. The conditions of the surgical act were therefore not documented. Intraoperatively, it was a complete anterior transverse corporal uterine rupture of 4 centimeters long, hemorrhagic with protrusion of the ovular sac. This finding could therefore explain this uterine rupture. Multiparity is generally considered a risk factor for UR through histological changes in the uterine muscle [11] . In this clinical observation, the patient was a pauciparous individual with a brief inter-genesis interval of just 13 months. The occurrence of uterine rupture in this case could be explained by repeated pregnancies that would exhaust the uterus already weakened by cesarean scars.

Uterine rupture may occur at any gestational age, but 75% - 80% of cases happen during labor attempts after a cesarean section or in the latter half of pregnancy [12] [13] . Spontaneous uterine rupture in pregnancy in the first trimester is therefore exceptional in literature. It occurred in our observation on a pregnancy of 12 weeks. The history of three uterine scars, including a probable corporal scar in the context of short intergenital space of 13 months, could explain this exceptional situation.

Uterine rupture in pregnancy in the first trimester presents heterogeneous and non-specific symptoms, leading to frequent delays in management and more severe complications. Abdomino-pelvic pain, peritoneal irritation, vomiting, and minimal metrorrhagia generally dominate the clinical picture [2] [14] . This non-specific symptomatology generally suggests either an abortion, a molar pregnancy, or an extrauterine pregnancy, as was the case in the present clinical case (heterotopic pregnancy).

Abdomino-pelvic ultrasound reveals hemoperitoneum [9] but particular attention should be paid to the continuity of uterine wall and the search for peritoneal hematoma, especially in pregnant woman with a history of cesarean section. The absence of total expulsion of the conception product into the peritoneal cavity in the present clinical observation was a factor increasing diagnostic doubt. The intrauterine visualization of a gestational sac containing a fetus with cardiac activity in a context of hemoperitoneum suggested a heterotopic pregnancy, one intrauterine and the other ruptured extrauterine. The diagnosis of uterine rupture was confirmed intraoperatively during laparotomy.

Regarding therapy, our approach called for surgical treatment framed by pre, intra, and postoperative resuscitation to ensure hemostasis. Conservative treatment was considered necessary to preserve the fertility of this 29-year-old woman with three parities, including one living child. The intraoperative difficulties in achieving hemostasis due to the fragility of the uterus and the involvement of the left uterine pedicle necessitated a subtotal hemostasis hysterectomy. Conservative treatment with repair of uterine lesions was undertaken in cases of spontaneous uterine rupture in young pregnancy reported by Ilunga-Mbaya [2] and Diaouga [14] . A subsequent pregnancy is not contraindicated in the case of UR, but the risk of recurrence (of the order of 4% - 19%) increases, especially in the case of corporal scar [11] . The patient’s vital prognosis was good given the resuscitation measures implemented, and the hemostasis achieved. However, the possibility of a subsequent pregnancy is impossible given the hysterectomy she underwent.

Uterine rupture is a rare but formidable obstetric complication. It is exceptional in the first trimester of pregnancy. It was favored by the uterine scar and short intergenesis space in the present clinical case. The clinical symptomatology was misleading, and the diagnosis was made at laparotomy. Conservative treatment with repair of uterine lesions proposed by most authors was technically impossible and necessitated a hemostasis hysterectomy. It’s important to remain attentive to clinical appropriately in any pregnant woman in the first trimester who has risk factors for uterine rupture.