[Uterine rupture due to placenta accreta at 22 weeks' pregnancy. Apropos of a case]

Although early rupture of the uterus is rare, that does not mean that it should not be considered. The case reported here was of a patient in her third pregnancy who suddenly presented with internal haemorrhage requiring immediate laparotomy at the 22nd week of pregnancy. When a broad rupture at the fundus was discovered total hysterectomy had to be carried out. Immediately afterwards the patient collapsed and this required a further operation which showed that one of the cervico-vaginal pedicles had slipped away from its ligature. After this, recovery was uncomplicated. Histological examination made it clear that the cause of the rupture was a placenta increta which had grown on the fundus which itself contained a fibroid. Early ruptures of the uterus are very rare and usually occur in a uterus that has been weakened by an anterior scar, or an abnormal development during the pregnancy or a malformation of the uterus. It is rare for placenta increta to be the cause. We have reviewed the clinical and histological material. Hysterectomy is carried out in order to ensure haemostasis and the procedure is discussed.