Placenta Percreta-Induced Uterine Rupture at 7th Week of Pregnancy After In Vitro Fertilization in a Primigravida...

Placenta percreta is the most severe form of abnormal placental attachment. Spontaneous uterine rupture due to placenta percreta is extremely rare and difficult to diagnose in the first trimester. Most prior cases were associated with some risk factor for placenta percreta. We report a case of placenta percreta-induced spontaneous uterine rupture at the 7th week of pregnancy after in vitro fertilization in a primigravida woman who was not otherwise at risk of placenta percreta.

A 34-year-old, primigravida woman at the 7th week of pregnancy presented with sudden severe abdominal pain. The patient was impregnated by frozen embryo transfer. The patient's antenatal course was unremarkable and she had no risk factor for placenta percreta. An emergency laparotomy was performed to diagnose the cause of hemoperitoneum and the operative findings included a hemoperitoneum of 2000 mL and a fundal uterine defect of 3 × 2 cm with placental tissue penetrating through the uterine serosa. Histopathologic examination confirmed the diagnosis of placenta percreta. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Placenta percreta is associated with serious morbidity and mortality during pregnancy, but it is quite rare and difficult to diagnosis in the first trimester. Emergency physicians should suspect uterine rupture due to placenta percreta in pregnant women with abdominal pain even in their first trimester of pregnancy and without risk factors of placenta percreta, especially in in vitro fertilization pregnancies.