Spontaneous rupture of the uterus due to placenta percreta at 25-weeks' gestation: a case report

Placenta percreta is a rare but serious complication of pregnancy, and is rarely diagnosed in the second trimester of pregnancy. We report a very rare case of placenta percreta accompanied by spontaneous uterine rupture at 25-weeks of gestation. A 30-year-old woman with severe abdominal pain was admitted to our hospital at 25 weeks of gestation. A laparotomy was immediately performed because of intraabdominal bleeding. The uterus revealed a perforation of the fundus. A supra-vaginal hysterectomy was performed. A pathological investigation of the uterus revealed placenta percreta. The patient had neither gravity nor any prior uterine operation. It is very rare for placenta percreta to be recognized in a primigravida woman or in the second trimester of pregnancy.

Intraoperative embolization for pelvic hemorrhage following termination of pregnancy

We describe a 37-year-old patient with placenta previa, placenta accreta and a history of four previous cesarean sections who experienced massive hemorrhage after mid-trimester abortion by dilation and evacuation.

Abdominal pain and hemoperitoneum in the gravid patient: a case report of placenta percreta

A 24-year-old woman, G4P3 at 14 weeks gestation, presented to the ED with acute abdominal pain, hemoperitoneum, and fetal demise. Emergent laparotomy showed placenta percreta, requiring hysterotomy for delivery of the fetus and gestational sac followed by oversewing of the uterine defect. Although an uncommon occurrence, clinicians should consider placenta percreta in the gravid patient who presents with acute abdominal pain and shock.

Post partum intra-abdominal hemorrhage due to placenta percreta

Placenta percreta is a serious complication of pregnancy. A 38-year-old nullipara presented at 25 weeks gestation with preterm labour. Spontaneous delivery was followed by retained placenta. During an attempt to remove the placenta manually placental tissue could not be distinguished. Initially, placenta increta was considered as the most likely diagnosis and conservative management was planned, but progressive shock emerged due to intra-abdominal hemorrhage and laparotomy was performed. Placenta percreta was diagnosed, followed by a supracervical hysterectomy. A review of risk factors, diagnostic tools and treatment possibilities is given.

Gravid uterine dehiscence: MR findings

Gravid uterine rupture can be a difficult diagnosis, both clinically and radiologically. Ultrasound has been successful in detection of some indirect signs of uterine rupture but thus far has shown little success in demonstrating the myometrial defect. We present the MR findings in a case of gravid uterine dehiscence in which the actual uterine wall defect was well demonstrated. Gross pathologic correlation is provided.

[Placenta praevia. Maternal and perinatal repercussions. Analysis of 170 cases]

One hundred and seventy cases with placenta previa, at Instituto Nacional de Perinatología, from 1989 to 1993, were reviewed. Incidence in our population was 0.62%; average maternal age was 31 years; the greater amount of cases was among nulliparae; in 72% of them there was the antecedent of uterine scar. Ultrasound diagnosis was done in 81% of the patients, and most frequent placental insertion type was the low one in 49%, and in 31%, total, central placenta. The first hemorrhagic episode occurred at a gestational age of 34 weeks. Most frequent complication was threatening pre-term delivery, and ethinyl adrianol was used as uterine inhibitor. All pregnancies were interrupted, via abdominal. Placental accretion was a frequent complication. Hemorrhage during the second half of gestation is one of the main causes of perinatal morbidity-mortality. Frequency of this complication is from 3% to 5%, of all pregnancies in an open population; and when it appears, is one of the most serious urgencies; so its early diagnosis and opportune treatment will diminish maternal and perinatal morbidity-mortality. Etiology is unknown, but diminished endometrial vascularization, at fundus and body, may be the causal factor. There are other predisposing causes as age, advanced maternal age, multiparity, tumours, scars and smoking. The objective of this study, was to analyze maternal and perinatal repercussions, of placenta previa, based on the experience at Instituto Nacional de Perinatología.

[Placenta praevia accreta and obstetric hysterectomy]

We present the case of a 38-years-old tertipara at full term with a diagnosis by ultrasound of placenta previa who underwent elective cesarean under spinal anesthesia. After a difficult birth, anomalous adhesion of the placenta prevented its removal and caused massive hemorrhage of the placental bed and hypovolemic shock. Blood volume was restored and emergency hysterectomy under general anesthesia was effected, as bleeding and hemodynamic state were brought under control. Abnormal heart rhythm appearing after the operation responded to treatment; postoperative recovery was unremarkable. Placenta accreta is a rare complication of placenta previa. Given that massive obstetric hemorrhage is associated with significant mortality and morbidity, both maternal and fetal, the anesthesiologist must be aware of potential problems that might arise in cases of placental accreta so that readiness can keep risk to a minimum.

[Uterine rupture after twenty-two weeks of amenorrhea due to placenta praevia percreta. A case report]

The authors report a case of rupture of the uterus 22 weeks after the LMP, due to placenta praevia percreta and requiring emergency hysterectomy to arrest bleeding, followed by urinary complications. With the predisposing factors of the scars of 4 previous cesarean sections and the low anterior insertion of the placenta, this exceptional case--in terms of its rarity and gravity--led the authors to undertake a review of the literature seeking other cases of this greatly feared obstetric complication. They review the clinical, ultrasonographic (notably the use of color Doppler) and paraclinical (MRI, cystoscopy) diagnostic approach necessary to make an accurate diagnosis of placenta percreta (if possible before any hemorrhagic complications). This situation virtually invariably requires hysterectomy to arrest bleeding, under very difficult conditions because of the massive hemorrhage involved. Mortality remains high and morbidity principally concerns the urinary complications frequently encountered.

Failed prostaglandin abortion associated with placenta accreta. A case report

Prostaglandin E2 vaginal suppositories are a highly effective method of second-trimester pregnancy termination. Management of a failed prostaglandin abortion must include a search for the cause of the failure. This case report is the first description of a failed prostaglandin abortion associated with placenta accreta.

Midtrimester hemoperitoneum caused by placenta percreta in association with elevated maternal serum alpha-fetoprotein level

We report a case of hemoperitoneum in the second trimester due to placenta percreta which was associated with an elevated maternal serum alpha-fetoprotein. A 29-year-old woman, gravida 4, para 1-0-2-1, was seen at 17 weeks' gestation with an acute abdomen. Maternal serum alpha-fetoprotein in a sample drawn 1 week previously revealed a value of 5.0 multiples of the median. At laparotomy, placenta percreta was discovered. This case of placenta percreta diagnosed in the second trimester was associated with an elevated maternal serum alpha-fetoprotein level. Physicians counseling patients with unexplained elevated maternal serum alpha-fetoprotein levels should include placenta accreta or percreta in the differential diagnosis and should maintain an awareness of its existence in patients with acute abdomen in pregnancy.

Severe preeclampsia and postpartum eclampsia associated with placenta previa and cesarean and hysterectomy: a case report

Several prior studies have demonstrated that the presence of placenta previa protects against the development of preeclampsia. Also, there are no reported cases of eclampsia following cesarean section and hysterectomy. However, we encountered a patient with total placenta previa and accreta who developed severe antepartum preeclampsia followed by the onset of eclamptic seizures after a cesarean section and a subtotal hysterectomy. This case confirms that severe preeclampsia may occur in patients with placenta previa and demonstrate that severe preeclampsia may occur after placental removal and even after subtotal hysterectomy, which removed most of the trophoblastic tissue.

Autologous blood transfusion for the patient with placenta previa complicated by placenta increta: a case report

The patient, who was 34 years of age, had previously had a transverse incision of the lower uterine segment cesarean section because of placenta previa. She was admitted to the hospital due to placenta previa again at 27 weeks of gestation in the current pregnancy. Ultrasound examination revealed placenta increta as well as placenta previa. In an attempt to avoid homologous blood transfusion at the time of profuse hemorrhage anticipated to occur during cesarean section, an autologous blood transfusion was planned. Fifteen hundred ml of autologous blood was collected by a leap-frog method during the 8 weeks prior to cesarean section. A cesarean hysterectomy was performed at 37 weeks of gestation because of placenta increta. Blood loss was estimated at 1,830 ml, and 1,500 ml of autologous blood was transfused. A leap-frog method of autologous blood collection for this pregnant woman with risk of massive hemorrhage was simple and beneficial, resulting in the preservation of more than 1,500 ml of autologous blood for transfusion.

Conservative surgical management of acute abdomen caused by placenta percreta in the second trimester

Placenta percreta accompanied by intraabdominal hemorrhage and acute abdomen in the second trimester is described. Suturing the myometrial defect created by the protruding placenta prolonged the pregnancy and achieved a viable fetus. Successful achievement of hemostasis, prolongation of the pregnancy, and survival of mother and fetus should encourage "conservative" surgery.

[Use of the Logotampon in gynecologic-obstetrical surgical hemorrhages. A case report]

The authors report a case of placenta accreta complicated by coagulation disturbance which required hysterectomy. In order to deal with widespread bleeding, they used a Logotheotopoulos pelvic tampon (Logotampon) and thus achieved a satisfactory operative result.

Sudden death following cesarean section for placenta previa and accreta

A case of disseminated intravascular coagulation (DIC) in a young woman after cesarean section for placenta previa and accreta is presented. Evidence of extensive pulmonary embolization by trophoblastic tissue, together with microthrombi in the cerebral and pulmonary blood vessels, is found at autopsy. Awareness of this syndrome and prompt action are necessary to prevent tragic consequences.

Placenta percreta with bladder invasion: report of three cases

Three cases are reported of placenta percreta with urinary bladder wall invasion. All three patients had complete placenta previa and each had five previous cesarean sections. Placental invasion caused a giant vesicouterine fistula in the first case. The second patient had a cesarean hysterectomy and the placental portion that penetrated the bladder wall was left to absorb spontaneously. The third patient underwent a cesarean supracervical hysterectomy during which the bladder invasion was left undisturbed. She received intraoperative methotrexate, and pelvic packing and bilateral hypogastric ligation were helpful in hemorrhage control.

[Placenta percreta over a cesarean scar with bladder invasion. General review and 2 case reports]

The authors report two new cases of placenta percreta on a caesarian scar with invasion of the bladder. On the basis of a review of the literature, they demonstrate its seriousness, which is always increased by the unexpected nature of the complications. They therefore recall the clinical and paraclinical factors which can provide grounds for suspecting this possibility, so that the hemostasis hysterectomy required can be carried out on the best possible conditions.

A case report: cervical pregnancy with placenta percreta an ultrasonic assisted diagnosis

A rare cervical pregnancy is reported, discussing the difficulty differentiating this condition from the cervical phase of an incomplete abortion. Placenta percreta further complicates this case. Ultrasound will give a firm diagnosis of cervical pregnancy and associated placenta percreta. Conservative and radical surgical care determined by vital signs are discussed.

Placenta praevia percreta invading the urinary bladder

A case of placenta praevia percreta involving the urinary bladder is presented. A classical Caesarean section was performed at 35 weeks' gestation but the placenta was left in situ and an elective hysterectomy was successfully performed 2 weeks postpartum.