Background Uterine rupture due to a morbidly adherent placenta is a rare obstetrical cause of acute abdominal pain in the pregnant patient. We present a case to add to the small body of published literature describing this diagnosis. Case A 32-year-old G5T2P1A1L2 with multiple prior cesarean sections presented at 21+3 weeks' gestation with abdominal pain and presyncope. Ultrasound showed a large volume of complex intraabdominal free fluid and a heterogenous placenta with irregular lacunae and increased vascularity extending to the posterior bladder wall. Exploratory laparotomy identified a uterine defect and a hysterectomy was performed due to significant bleeding. Pathology confirmed a diagnosis of placenta percreta. Conclusion Early recognition and management of uterine rupture due to a morbidly adherent placenta are essential to prevent catastrophic hemorrhage.

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Given that PWD is a well-accepted noninvasive marker of atrial electrophysiology, our results suggest that these patients demonstrate adverse atrial remodeling predisposing to atrial arrhythmia.

Only when an intrapartum TOC is needed does the OASIS rate substantially increase, reflecting the underlying indication for TOC is leading to more intervention associated with risk of OASIS.