Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature

Abstract

Background Cases of uterine wall thinning and placental abnormalities complicated with systemic lupus erythematosus (SLE) during pregnancy have been reported in Asian countries for ten years. Long-term steroid use can cause muscle degeneration, but the mechanism of myometrium thinning was not known. Through the review of published articles, this report is the first review of cases to discuss the pathogenesis and clinical features of thinned myometrium and placenta accreta spectrum (PAS) in pregnant patients with SLE. Case presentation A twenty-nine-year-old primigravida with a history of lupus enteritis and paralytic ileus had a natural conception after less than two years of steroid treatment. An ultrasonographic study showed a thin uterine wall with a widespread thick placenta on the entire surface of the uterine cavity in the third trimester. At the 39th gestational week, she underwent a cesarean section due to the failure of the uterus to contract, even though the injection of oxytocin. There were several engorged vessels on the surface of the anterior uterine wall at the time of laparotomy. We decided to perform a hysterectomy because diffuse PAS replaced her uterus. Conclusion A review of reported cases and our case shows an unusual complication of SLE that might be related to the particular condition of the estrogen-mediated immune system. Clinicians should always pay attention to the possibility of uterine wall thinning as uterine atony and the structural abnormality of the placenta for SLE patients with the unscarred uterus.

Extensive fundal placenta accreta spectrum (PAS) in a nulliparous patient with an unscarred uterus and systemic lupus erythematosus (SLE) necessitating cesarean hysterectomy at delivery

“…Notwithstanding, PAS may occur in patients without previous uterine surgery and very rarely among nulliparous patients with unscarred uteri. Interestingly, previous reports have described thinning of the myometrium and PAS in nulliparous patients with systemic lupus erythematosus necessitating hysterectomy at delivery have been reported previously [ 12 , 13 ]. Although the pathophysiology of the association between systemic lupus and extensive PAS remains unclear, it is plausible that myometrial thinning resulting from chronic steroid exposure may contribute to this rare occurrence [13] , [14] , [15] .…”

Evaluation of the holding-up uterus technique for placenta accreta spectrum cesarean hysterectomy in shocked patients with a high shock index: a case series study

“…Other surgical procedures that caused surgical damage to the uterine wall, such as surgical hysteroscopy, and suction curettage were observed in three cases. Notable history includes one patient with a history of UAE, two patients with a uterine cavity length of less than 5 cm at non-pregnancy, and two patients with systemic lupus erythematosus [ 11 ]. In vitro fertilization (using cryopreserved embryos) was performed in 7 cases.…”