Uterine rupture after prior conservative management of placenta accreta

There is little evidence for counseling patients who seek uterine conservation in the setting of placenta accreta.

We report the case of a 37-year-old woman with retained placenta accreta after vaginal delivery. Attempts at transvaginal removal failed, and the placenta was removed through a fundal hysterotomy with bilateral uterine artery ligations performed to control blood loss. She conceived a second pregnancy 11 months later and sustained spontaneous fundal uterine rupture at 26.5 weeks of gestation with a recurrent accreta found at the rupture site. The newborn survived but has residual musculoskeletal morbidity and developmental delay at 1 year of age.

Patients undergoing conservative treatment of placenta accreta in the setting of a fundal hysterotomy should be cautioned about recurrent accreta and uterine rupture.