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Conservative management of spontaneous uterine perforation associated with placenta accreta: a case report
Robert B Gherman1, Ernest G Lockrow, Donald J Flemming
1Division of Maternal/Fetal Medicine, Department of Obstetrics and Gynecology, National Naval Medical Center, Bethesda, Maryland 20889, USA.
Background:
Placenta accreta occurring in an unscarred uterus is exceedingly rare. Previous cases of spontaneous uterine perforation associated with placenta accreta were treated with hysterectomy.
Case:
A nulliparous woman was clinically diagnosed with placenta accreta when spontaneous vaginal delivery was complicated by postpartum hemorrhage and a retained placenta. Magnetic resonance imaging subsequently revealed focal areas of placenta accreta. Acute-onset abdominal pain and cul-de-sac fluid prompted diagnostic laparoscopy, which revealed a spontaneous uterine perforation in the right posterior-lateral aspect of the uterus. This area was oversewn, and the patient received 2 weeks of postoperative antibiotics because of Enterococcus faecalis bacteremia.
Conclusion:
Spontaneous uterine perforation associated with placenta accreta can be managed conservatively.
