Placenta percreta as a cause of uterine rupture in the second trimester: Case report

Placenta accreta spectrum is a very life-threatening obstetrical condition whose rate increased significantly the past years due to the increase of caesarean deliveries. In some rare cases, it can cause uterine rupture which needs to be diagnosed and managed quickly to avoid catastrophic outcomes.

We present a case of a 33-year-old patient who was admitted to the emergency room for signs of shock at 29 weeks of a poorly supervised pregnancy, secondary to a spontaneous uterine rupture on a previously scarred uterus by a caesarean delivery two years prior to the events. She presented with massive haemoperitoneum with no vaginal bleeding. Foetus was in bradycardia. Quick total hysterectomy allowed favorable maternal and foetal outcome.

Placenta accreta spectrum (PAS) occurs when the placenta becomes abnormally adherent to the myometrium and serosa rather than the uterine decidua. Its most important complication is hemorrhage after delivery of the placenta. In rare cases it can lead to spontaneous uterine rupture at any trimester, as it was the case of our patient. Antepartum diagnosis by ultrasound examination is recommended to avoid complications and improve management. It should be carefully done in high-risk patients of PAS. PAS is associated with high maternal and foetal morbidity and mortality. Definitive diagnosis is obtained after pathology examination of the specimen.

Uterine rupture should be considered a differential diagnosis for abdominal pain in any trimester, in case of shock even in the absence of vaginal bleeding, especially when associated to abnormal placentation. Quick diagnosis, management and intervention improves survival rate and decreases maternal and foetal morbidity.