Midgestational Uterine Rupture With Spontaneous Bladder Disruption due to Placenta Percreta: A Case Report

Uterine rupture due to placenta percreta in midgestation is rare, particularly when associated with spontaneous bladder disruption.

A 36-year-old gravida 9, para 5 woman presented at 20 weeks of gestation with complaints of vaginal bleeding triggered by urination and walking. Ultrasonography performed at 17 + 5 weeks' gestation indicated placenta accreta spectrum with possible bladder invasion. On admission, the initial evaluation revealed stable vital signs, a closed cervix with no active bleeding, and a reactive nonstress test, and the patient was kept under observation. She later developed abrupt hypogastric pain accompanied by gross hematuria. Physical examination revealed stable vital signs, vaginal bleeding, and uterine contractions. Emergent laparotomy revealed rupture of the anterior uterine wall at the site of the previous cesarean scar, with extrusion of a nonviable fetus into the abdominal cavity and spontaneous bladder disruption due to extensive placental invasion through the uterine serosa into the bladder. Hemorrhagic adnexal cysts were incidentally identified. A subtotal hysterectomy, left salpingo-oophorectomy, and bladder repair were performed. The patient recovered well; however, during the 2-year follow-up, she reported symptoms of overactive bladder.

When placenta percreta is suspected antenatally, the rare possibility of uterine rupture and risk of spontaneous bladder rupture must be kept in mind.