Placenta percreta with painless uterine rupture at the 2nd trimester

A pregnant lady at 27 weeks and 2 days gestation with a known placenta previa major and a history of previous lower segment cesarean section had a sudden severe painless vaginal bleeding. At laparotomy a uterine rupture was noted, no hemoperitoneum found and placenta percreta was diagnosed. This is the first case reported in the Kingdom of Saudi Arabia, it is rare, only 3 cases of silent or asymptomatic uterine rupture secondary to placenta percreta were reported in the literature in the last 30-years. Non-invasive methods could help in the diagnosis or increase suspicion of placenta percreta, therefore, proper management could be arranged through a multi-disciplinary team.