Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: A case report

Abstract

Several cases in which uteruses have been preserved in women with placenta percreta have been reported. We herein report a 38-year-old woman with a history of previous cesarean section who was admitted with lower abdominal pain and vaginal bleeding at 31 weeks of gestation. An urgent exploratory laparotomy revealed active bleeding from the uterine rupture on the posterior uterine wall. A female infant weighing 1560 g, with Apgar scores of 1,1, and 3 at 1, 5, and 10 min, respectively, was delivered, and the placenta was removed. We performed bilateral uterine vessel occlusion, followed by wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, and an intramuscular injection of 0.2 mg methylergonovine, primary repair of the defect, and an additional 24-h postoperative oxytocin infusion (30 IU in 5% dextrose 500 mL) to preserve the uterus successfully. Although the overall blood loss was 3700 mL, no disseminated intravascular coagulopathy occurred after the patient had received adequate blood transfusion. The postoperative pathological diagnosis was placenta percreta with uterine rupture. The patient and her baby were discharged uneventfully. In some cases of spontaneous uterine rupture secondary to placenta percreta, we can preserve the uterus by performing bilateral uterine vessel occlusion and wedge resection of the ruptured uterine wall.

Placenta Percreta-Induced Uterine Rupture Diagnosed By Laparoscopy in the First Trimester

“…Conservative treatments for placenta percreta-induced uterine rupture have been reported, such as uterine curettage along with packing, adjuvant chemotherapy, and bilateral uterine vessel occlusion 18, 19. However, considering a 4-fold mortality rate associated with these conservative treatments as compared to hysterectomy, the latter is usually preferred in an emergent situation 5.…”

Abnormal Placentation

“…Although very rare, uterine rupture secondary to placenta percreta has also been reported. 94,95 Prenatal Diagnosis…”

Rupture of a pregnant unscarred uterus in an early secondary trimester: A case report and brief review

“…Among these, traumatic uterus might be one of the most important risk factors, and has contributed to the occurrence of scarred uterus and a subsequent tendency to uterine rupture. For example, previous cesarean section, myomectomy, iatrogenic uterine perforation (curettage), and abnormal placentation (accreta, increta and percreta) or abnormal implantation will result in traumatic uterus 5–10 . However, uterine rupture, which occurs in the unscarred uterus and in the early second trimester is extremely rare 11 .…”

“…For example, previous cesarean section, myomectomy, iatrogenic uterine perforation (curettage), and abnormal placentation (accreta, increta and percreta) or abnormal implantation will result in traumatic uterus. [5][6][7][8][9][10] However, uterine rupture, which occurs in the unscarred uterus and in the early second trimester is extremely rare. 11 Herein, the case of a second trimester unscarred uterine rupture occurring in a 31-year-old woman is reported.…”