BACKGROUND: Placenta accreta occurring in an unscarred uterus is exceedingly rare. Previous cases of spontaneous uterine perforation associated with placenta accreta were treated with hysterectomy. CASE: A nulliparous woman was clinically diagnosed with placenta accreta when spontaneous vaginal delivery was complicated by postpartum hemorrhage and a retained placenta. Magnetic resonance imaging subsequently revealed focal areas of placenta accreta. Acute-onset abdominal pain and cul-de-sac fluid prompted diagnostic laparoscopy, which revealed a spontaneous uterine perforation in the right posterior-lateral aspect of the uterus. This area was oversewn, and the patient received 2 weeks of postoperative antibiotics because of Enterococcus faecalis bacteremia. CONCLUSION: Spontaneous uterine perforation associated with placenta accreta can be managed conservatively.
BACKGROUND:Placenta accreta occurring in an unscarred uterus is exceedingly rare. Previous cases of spontaneous uterine perforation associated with placenta accreta were treated with hysterectomy. CASE: A nulliparous woman was clinically diagnosed with placenta accreta when spontaneous vaginal delivery was complicated by postpartum hemorrhage and a retained placenta. Magnetic resonance imaging subsequently revealed focal areas of placenta accreta. Acute-onset abdominal pain and cul-de-sac fluid prompted diagnostic laparoscopy, which revealed a spontaneous uterine perforation in the right posterior-lateral aspect of the uterus. This area was oversewn, and the patient received 2 weeks of postoperative antibiotics because of Enterococcus faecalis bacteremia. CONCLUSION: Spontaneous uterine perforation associated with placenta accreta can be managed conservatively.