Uterine Rupture Secondary to Placenta Percreta on Previa: A Case Report of Successful Management by Caesarian Hysterectomy
Science Journal of Public Health
Volume 6, Issue 3, May 2018, Pages: 82-85
Received: Apr. 12, 2018;
Accepted: May 8, 2018;
Published: May 31, 2018
Views 954 Downloads 46
Dawit Sereke, Department of Obstetrics and Gynecology, Mendefera Regional Referral Hospital, Mendefera, Eritrea
Habte Hailemelekot, Department of Obstetrics and Gynecology, Mendefera Regional Referral Hospital, Mendefera, Eritrea
Abduselam Hagos, Department of Obstetrics and Gynecology, Orotta National Referral Hospital, Asmara, Eritrea
Elias Teages Adgoy, Department of Community Medicine and Primary Health Care, Orotta School of Medicine and Dentistry, Asmara, Eritrea
Background: Placenta accreta is a general term used to describe the clinical condition when part of the placenta, or the entire placenta, invades and is inseparable from the uterine wall. Its incidence is growing due to the rising rate of cesarean sections and advanced maternal age on delivery. It is becoming the foremost cause of obstetric hemorrhage leading to significant maternal and fetal morbidity and even mortality. Rarely placenta accreta may lead to spontaneous uterine rupture in the second or third trimester. Case report: A 28-year-old woman gravida 4, para 3, was admitted at the maternity ward of Mendefera regional referral hospital, at a gestational age of 27 weeks due to vaginal bleeding. She had history of 3 time’s caesarian section. At admission her vital sign was stable and her complete blood count was normal, ultrasound showed anterior placentation with partial placenta previa. She was given Dexamethasone 6 gm. IM twice daily for 2 days to enhance lung maturity. At 36 weeks of gestation, she experienced massive vaginal bleeding. A decision was made to perform emergency cesarean section. The possibility of morbidly adherent placenta was considered. Intra-operatively, the placenta was found with engorged blood vessels under the rectus fascia with ruptured uterus and there was adhesion of rectus sheath with part of the uterus. A transverse uterine incision was made at the upper border of the placental attachment to uterus to deliver the fetus. After successful delivery of the fetus, the placenta was found to be densely adhered to the lower uterine segment, penetrating through it and adhered to the posterior wall of the urinary bladder. It was decided to do caesarian hysterectomy with the placenta left in situ. During discharge both the mother and the baby were in good condition. Conclusion: Placenta accreta is a potentially life-threatening obstetric condition that requires a meticulous approach to management. If a multiparous woman with a previous caesarian section is found to have placenta previa, the possibility of placenta accreta should be considered in the diagnosis of the patient. Grayscale ultrasonography is sufficient for the diagnosis of placenta accreta. The recommended management of placenta accreta is planned caesarian hysterectomy.
Elias Teages Adgoy,
Uterine Rupture Secondary to Placenta Percreta on Previa: A Case Report of Successful Management by Caesarian Hysterectomy, Science Journal of Public Health.
Vol. 6, No. 3,
2018, pp. 82-85.
Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa–placenta accreta. American Journal of Obstetrics & Gynecology. 1997 Jul 1; 177(1):210-4.
Jameela S, Policarp B, Thankam U, Chellamma N. A Comparative Study on Maternal and Fetal Outcome in Cases of Placenta Previa with Previous Cesarean Section and Without Previous Cesarean Section.
Sparić R, Mirković L, Ravilić U, Janjić T. Obstetric complications of placenta previa percreta. Vojnosanitetskipregled. 2014; 71 (12):1163-6.
ACOG committee opinion. Placenta accreta. ACOG women’s health care physicians, July 2012; (529).
Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. American Journal of Obstetrics & Gynecology. 2005 May 1; 192 (5):1458-61.
Matsubara S, Takahashi H, Lefor AK. The “morbidly adherent placenta” team: recognition and respect are needed. American Journal of Obstetrics & Gynecology. 2017 Jul 1; 217 (1):101-2.
Armstrong-Kempter S, Kapurubandara S, Trudinger B, Young N, Arrage N. A Case of Placenta Percreta Managed with Sequential Embolisation Procedures. Case Reports in Obstetrics and Gynecology, 2018.
Guleria K, Gupta B, Agarwal S, Suneja A, Vaid N, Jain S. Abnormally invasive placenta: changing trends in diagnosis and management. ActaobstetriciaetgynecologicaScandinavica. 2013 Apr 1; 92 (4): 461-4.
Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstetrics & Gynecology. 2006 Apr 1; 107 (4): 927-41.
Biler A, Ekin A, Gezer C, Apaydın N, Solmaz U, Özeren M. Spontaneous uterine rupture due to placenta percreta in second trimester of pregnancy: A case report. Gazi Medical Journal. 2016 Jun 23; 27 (3).
Farooq F, Siraj R, Raza S, Saif N. Spontaneous Uterine Rupture Due to Placenta Percreta in a 17-Week Twin Pregnancy. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2016 Nov; 26 (11): 121-3.
Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG: An International Journal of Obstetrics &Gynaecology. 2014 Jan 1; 121 (1): 62-71.
Zelop CM, Harlow BL, FrigolettoJr FD, Safon LE, Saltzman DH. Emergency peripartum hysterectomy. American journal of obstetrics and gynecology. 1993 May 1; 168 (5): 1443-8.
Chen C, Wang Y, Lin J, Chiu Y, Wu H, and Liu W. Journal of Obstetrics and Gynecology Research Ó2010 Japan Society of Obstetrics and Gynecology. 2010.
Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology. 2017 Jul 1; 217 (1): 27-36.
David SN, Shibu CK, Mariam KT, Usha S, Supriya K, Bino B. Endovascular balloon occlusion of the aorta for placenta percreta during cesarean hysterectomy. Indian Journal of Case Reports. 2018; 4 (1): 14-6.
Shetty S, Bagade P, Kumar S. CASE REPORT: UTERUS SAVED IN A CASE OF ANTENATALLY DIAGNOSED PLACENTA ACCRETA. GLOBAL JOURNAL FOR RESEARCH ANALYSIS. 2018 Feb 8; 6 (11).
Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. Journal of ultrasound in medicine. 1992 Jul 1; 11 (7): 333-43.
Comstock CH, Love JJ, Bronsteen RA, Lee W, Vettraino IM, Huang RR, Lorenz RP. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. American Journal of Obstetrics & Gynecology. 2004 Apr 1; 190 (4): 1135-40.
Kayem G, Davy C, Goffinet F, Thomas C, Clement D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta. Obstetrics & Gynecology. 2004 Sep 1; 104 (3): 531-6.
Mehdi ParvaMD, Dmitri Chamchad, Joan Keegan, Andrew Gerson, Jay Horrow. Placenta percreta with invasion of the bladder wall: management with a multi-disciplinary approach. A case report. Journal of Clinical Anesthesia (2010) 22, 209–212.
Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, Winer N, Pierre F, Benachi A, Dreyfus M, Bauville E. Maternal outcome after conservative treatment of placenta accreta. Obstetrics & Gynecology. 2010 Mar 1; 115 (3): 526-34.