Paradoxical Uterine Rupture and Fetal Survival in Placenta Accreta: A Case Report
Thomas J Curtis1, Paul D Timmons1, Demi J Blair1
1Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals NHS (National Health Service) Foundation Trust, Norwich, GBR.
Abnormally invasive placentation can cause uterine rupture but may also enable fetal survival despite a prolonged interval between rupture and delivery. This case highlights a rare scenario with a positive fetal outcome.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Case Reports
Background:
- A prior cesarean delivery with an atypical uterine incision complicated a subsequent pregnancy.
- The patient presented with abdominal pain at 25 weeks' gestation, indicating a potential uterine defect.
Observation:
- Ultrasound revealed an anterior uterine wall defect, confirmed at a tertiary center.
- During laparotomy for delivery, uterine rupture was evident with visible amniotic membrane and placental edge.
Findings:
- The infant survived despite a 19.5-hour rupture-to-delivery interval.
- Abnormally invasive placentation was confirmed histopathologically and is hypothesized to have contributed to the rupture and fetal survival.
Implications:
- This case suggests abnormally invasive placentation may prevent complete placental separation, potentially aiding fetal survival in uterine rupture.
- Highlights the importance of careful uterine scar assessment and management in subsequent pregnancies.
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