Placenta percreta causing spontaneous uterine rupture and intrauterine fetal death in an unscared uterus: A case report

Enebe, Joseph Tochukwu; Ofor, Ifeanyichukwu Jude; Okafor, I. I.

doi:10.1016/j.ijscr.2019.10.039

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor (22/84 [26.2%]), 3,4,11,34,36,56–62,84–90 mainly oxytocin and misoprostol, and a history of a curettage procedure (16/84 [19%]) 4,21,23,34,63–69,91–93 …”

Section: Resultsmentioning

confidence: 99%

“…4,9,11,13,21,25,26,32,35,36, The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor (22/84 [26.2%]), 3,4,11,34,36,[56][57][58][59][60][61][62][84][85][86][87][88][89][90] mainly oxytocin and misoprostol, and a history of a curettage procedure (16/84 [19%]). 4,21,23,34,[63][64][65][66][67][68][69][91][92][93] Fourteen women (19%) were 35 years or older, 15,23,30, 34,78-80,87,89,90,94-96 and 4 (4.8%) were grand multiparous, with 5 or more past deliveries. 3,81,86,87 Three women (3.6%) were pregnant with a macrocosmic baby (≥4000 g), …”

Section: Etiological and Risk Factorsmentioning

confidence: 99%

“…91,[94][95][96] Labor-related complications contributed to 4 ruptures; in 3 women (3.6%), 36,84,88 the labor was prolonged, and in the fourth, the labor was obstructed. 30 Nine women (10.7%) had a morbidly adherent placenta, mainly a placenta percreta, 13,15,[74][75][76][77]93,94,97 and 2 (2.4%) had adenomyosis. 96,98 A uterine anomaly was present in 8 ruptures (9.5%): 3 bicornuate uteri, 9,72,73 2 didelphys, 70,97 1 arcuate with right tubal occlusion, 26 and 2 unicornuate with noncommunicating rudimentary horns.…”

Section: Etiological and Risk Factorsmentioning

confidence: 99%

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Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Sgayer,

Dabbah,

Farah

et al. 2023

Obstetrical &Amp; Gynecological Survey

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Importance Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes. Objective To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus. Evidence Acquisition PubMed was searched for the phrases “uterine rupture,” “unscarred,” and “spontaneous.” Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included. Results We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries. Conclusions and relevance Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy. Target Audience Obstetrician-gynecologists, family medicine physicians. Learning Objectives After completing this activity, the learner will be better able to describe the consequences of spontaneous rupture of the unscarred uterus to the mother and fetus; discuss risk factors for spontaneous rupture of the unscarred uterus and its potential occurrence in nulliparous, antepartum, and the first trimester; and discuss how timely assessment of a pregnant woman presenting with abdominal pain impacts survival of the mother and child.

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Section: Resultsmentioning

confidence: 99%

Section: Etiological and Risk Factorsmentioning

confidence: 99%

Section: Etiological and Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Sgayer,

Dabbah,

Farah

et al. 2023

Obstetrical &Amp; Gynecological Survey

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“… Hysterectomy Huang et al, (2005) [15] G3P2, near cornual pregnancy 16 weeks Accreta In fatal condition due to massive hemorrhage. Multiple organ failure Emergency hysterectomy Enebe et al, (2019) [15] multiparous 33 weeks Percreta Spontaneous uterine rupture Hypovolemic shock Intrauterine foetal death Okaniwa et al, (2020) [5] Use of uterotonics and manual removal of placenta 39 weeks, second day of postpartum Accreta Hysterectomy. Blood loss during surgery was 3100 ml; Total of blood transfusion was 14 IU TBC, 960 ml FFP, and 20 IU PC.…”

Section: Discussionmentioning

confidence: 99%

Placenta accreta spectrum on an unscarred uterus in the third-trimester pregnancy: two rare cases at Tu Du Hospital in Vietnam

Vuong

Nguyen

2022

International Journal of Surgery Case Reports

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“…PAS is characterized by the subtypes accreta, increta, and and percreta delineating the extent of this invasion 1 . Percreta is the most extreme case, in which invasion extends through the uterine wall and sometimes into neighboring organs such as the bladder 1,3 . Nearly all accreta patients are also afflicted with previa, a condition in which the placenta is located in the lower segment of the uterus, directly covering the cervix 4,5 .…”

Section: Introductionmentioning

confidence: 99%

PRG2 and AQPEP are misexpressed in fetal membranes in placenta previa and percreta

Zhang

Hannibal

Rivera

et al. 2020

Preprint

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The obstetrical conditions placenta accreta spectrum (PAS) and placenta previa are a significant source of pregnancy-associated morbidity and mortality, yet the specific molecular and cellular underpinnings of these conditions are not known. In this study, we identified misregulated gene expression patterns in tissues from placenta previa and percreta (the most extreme form of PAS) compared with control cases. By comparing this gene set with existing placental single-cell and bulk RNA-Seq datasets, we show that the upregulated genes predominantly mark extravillous trophoblasts. We performed immunofluorescence on several candidate molecules and found that PRG2 and AQPEP protein levels are upregulated in both the fetal membranes and the placental disk in both conditions. While this increased AQPEP expression remains restricted to trophoblasts, PRG2 is mislocalized and is found throughout the fetal membranes. Using a larger patient cohort with a diverse set of gestationally aged-matched controls, we validated PRG2 as a marker for both previa and PAS and AQPEP as a marker for only previa in the fetal membranes membranes. Our findings suggest that the extraembryonic tissues surrounding the conceptus, including both the fetal membranes membranes and the placental disk, harbor a signature of previa and PAS that reflects increased trophoblast invasiveness.

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Placenta percreta causing spontaneous uterine rupture and intrauterine fetal death in an unscared uterus: A case report

Cited by 13 publications

References 8 publications

Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature

Placenta accreta spectrum on an unscarred uterus in the third-trimester pregnancy: two rare cases at Tu Du Hospital in Vietnam

PRG2 and AQPEP are misexpressed in fetal membranes in placenta previa and percreta

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