Jung-Hsiu Hou1, Tung-Heng Lee1, Sheng-Yuan Wang1, Hung-Chung Lai2, Shih-Peng Mao3. 1. Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 2. Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 3. Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. Electronic address: msp1107@gmail.com.
Abstract
OBJECTIVES: Risk factors for placenta percreta are placenta previa and prior cesarean delivery. Placenta percreta-induced ruptures at non-cesarean sites are very rare, particularly in the early second trimester. CASE REPORT: A 30-year-old woman with a prior cesarean delivery was brought to our emergency department at 17 weeks' gestation for sudden-onset consciousness loss and generalized convulsions. Hypovolemic shock was identified. Computed tomography scans suggested uterine rupture and massive ascites, r/o hemoperitoneum. Emergency exploratory laparotomy revealed a ruptured hole over the left uterine fundus with protruding placental tissue; placenta percreta was impressed. An intact intrauterine sac was dissected and removed. The placenta was removed and hysterorrhaphy was completed. CONCLUSION: Placenta percreta is dangerous and is rarely seen in the early second trimester. Uterine rupture should always be kept in mind in pregnant woman with acute abdomen associated with hypovolemic shock, even in those of early pregnancy without scarred uterus. Routine sonographic examination of placentation, even in early second trimester, should be emphasized.
OBJECTIVES: Risk factors for placenta percreta are placenta previa and prior cesarean delivery. Placenta percreta-induced ruptures at non-cesarean sites are very rare, particularly in the early second trimester. CASE REPORT: A 30-year-old woman with a prior cesarean delivery was brought to our emergency department at 17 weeks' gestation for sudden-onset consciousness loss and generalized convulsions. Hypovolemic shock was identified. Computed tomography scans suggested uterine rupture and massive ascites, r/o hemoperitoneum. Emergency exploratory laparotomy revealed a ruptured hole over the left uterine fundus with protruding placental tissue; placenta percreta was impressed. An intact intrauterine sac was dissected and removed. The placenta was removed and hysterorrhaphy was completed. CONCLUSION: Placenta percreta is dangerous and is rarely seen in the early second trimester. Uterine rupture should always be kept in mind in pregnant woman with acute abdomen associated with hypovolemic shock, even in those of early pregnancy without scarred uterus. Routine sonographic examination of placentation, even in early second trimester, should be emphasized.
Authors: Ahmed Issak Hussein; Abdikarim Ali Omar; Hodan Abdi Hassan; Mohamed Mukhtar Kassim; Abdisalam Abdullahi Yusuf; Ahmed Adam Osman Journal: Int Med Case Rep J Date: 2022-10-06