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Spontaneous uterine rupture at the 21st week of gestation caused by placenta percreta

  • Materno-fetal Medicine
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Abstract

Purpose

To describe the management of a ruptured uterus caused by placenta percreta in the 21st week of gestation.

Methods

We present a case report of a 33-year-old patient with a ruptured uterus in the 21st week of gestation who presented at the Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Luebeck. Therapeutic management was performed by laparoscopy, and consecutive laparotomy and hysterectomy.

Results

A 33-year-old patient presented with severe abdominal pain in the 21st week of gestation at the department of abdominal surgery. A laparoscopy was performed to exclude appendicitis. There was about one liter of blood in the peritoneal cavity and a small, bleeding lesion in the fundus uteri was found which was coagulated. The blood was evacuated and the patient returned to department of gynecology. One hour after the first operation, the patient developed signs of hypovolemic shock and ultrasound showed absent fetal heart beat. An immediate laparotomy was performed and a ruptured uterus was detected. The fetus was removed and a hysterectomy performed. Pathology results showed a placenta percreta. After a few days in hospital and transfusion of 4 liters of blood the patient was discharged in a healthy condition.

Conclusions

In a pregnant woman with severe abdominal pain even in the 21st week of gestation a placenta percreta has to be considered as a differential diagnosis. If there is no evidence of other causes, laparoscopy may help to confirm the diagnosis and hysterectomy is a life saving intervention.

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References

  1. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al (2006) Maternal morbidity associated with multiple repeated cesarean deliveries. Obstet Gynecol 107:1226–1232

    Article  PubMed  Google Scholar 

  2. Pelosi MA III, Pelosi MA (1999) Modified caesarean hysterectomy for placenta percreta with bladder invasion: retrovesical lower uterine segment bypass. Obstet Gynecol 93:830–833

    Article  PubMed  Google Scholar 

  3. O’Brien JM, Barton JR, Donaldson ES (1996) The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 175:1632–1638

    Article  PubMed  Google Scholar 

  4. Cholkeri-Singh A, LaBarge A (2007) Spontaneous heterotopic triplets: a case report. Fertil Steril 88(4):968, e5–7

    Article  PubMed  Google Scholar 

  5. Hornemann A, von Koschitzky H, Bohlmann MK, Hornung D, Diedrich K, Taffazoli K (2009) Isolated pyosalpinx in a 13-year-old virgin. Fertil Steril 91(6):2732, e9–10

    Article  PubMed  Google Scholar 

  6. Hornemann A, Holl-Ulrich K, Finas D, Altgassen C, Diedrich K, Hornung D (2008) Laparoscopic management of early primary omental pregnancy. Fertil Steril 89:991, e9–11

    Article  PubMed  Google Scholar 

  7. Fleisch MC, Lux J, Schoppe M, Grieshaber K, Hampl M (2008) Placenta percreta leading to spontaneous complete uterine rupture in the second trimester. Example of a fatal complication of abnormal placentation following uterine scarring. Gynecol Obstet Invest 65(2):81–83

    Article  PubMed  CAS  Google Scholar 

  8. Vaknin Z, Maymon R, Mendlovic S, Barel O, Herman A, Sherman D (2008) Clinical, sonographic, and epidemiologic features of second- and early third-trimester spontaneous antepartum uterine rupture: a cohort study. Prenat Diagn 28(6):478–484

    Article  PubMed  Google Scholar 

  9. Honig A, Rieger L, Thanner F, Eck M, Sutterlin M, Dietl J (2005) Placenta percreta with subsequent uterine rupture at 15 weeks of gestation after two previous cesarean sections. J Obstet Gynaecol Res 31(5):439–443

    Article  PubMed  Google Scholar 

  10. Medel JM, Mateo SC, Conde CR, Cabistany Esqué AC, Ríos Mitchell MJ (2010) Spontaneous uterine rupture caused by placenta percreta at 18 weeks’ gestation after in vitro fertilization. J Obstet Gynaecol Res 36(1):170–173

    Article  PubMed  Google Scholar 

  11. Roeters AE, Oudijk MA, Heydanus R, Bruinse HW (2007) Pregnancy outcome after intra-abdominal bleeding due to placenta percreta at 14 weeks of gestation. Obstet Gynecol 109(2 Pt2):574–576

    Article  PubMed  Google Scholar 

  12. Henrich W, Fuchs I, Ehrenstein T, Kjos S, Schmider A, Dudenhausen JW (2002) Antenatal diagnosis of placenta percreta with planned in situ retention and methotrexate therapy in a woman infected with HIV. Ultrasound Obstet Gynecol 20:90–93

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

    Amadeus Hornemann & Sven Kehl

  2. Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany

    Michael K. Bohlmann, Klaus Diedrich, Andreas Kavallaris, Katharina Kelling & Friederike Hoellen

Authors
  1. Amadeus Hornemann
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  2. Michael K. Bohlmann
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  3. Klaus Diedrich
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  4. Andreas Kavallaris
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  5. Sven Kehl
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  6. Katharina Kelling
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  7. Friederike Hoellen
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Corresponding author

Correspondence to Friederike Hoellen.

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Hornemann, A., Bohlmann, M.K., Diedrich, K. et al. Spontaneous uterine rupture at the 21st week of gestation caused by placenta percreta. Arch Gynecol Obstet 284, 875–878 (2011). https://doi.org/10.1007/s00404-011-1927-5

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  • DOI: https://doi.org/10.1007/s00404-011-1927-5

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