Successful pregnancy in a woman with uterine scarring by transverse fundal cesarean section

Uterine rupture in the third trimester of a pregnancy subsequent to a cesarean section by transverse uterine fundal incision: A case report and literature review

Cesarean section via a transverse uterine fundal incision is performed in patients with placenta previa to reduce blood loss. We describe a case of uterine rupture in a pregnant woman who previously underwent a cesarean section and recovered from cardiac arrest by multidisciplinary management.

"Leaving the placenta in situ approach" (LISA) in a patient with placenta increta leading to delayed spontaneous delivery of the placenta

Aim: Based on the recent FIGO recommendations, we wish to report on preservation of the uterus in a patient with placenta increta by applying the leaving the placenta in situ approach.Methods: A 30-year-old gravida 2, Para 1 was referred at 25 + 5 gestational weeks due to a placenta previa bipartita increta diagnosed by transvaginal ultrasound, a history of a cesarean and vaginal bleeding. After informed consent, the parents opted for conservative treatment. The patient was admitted and the options of treatment were communicated within a multidisciplinary team. At 31 + 4 gestational weeks, severe recurrent hemorrhage led to a repeat cesarean.Results: A boy of 1910 g was delivered and the placenta was left in situ. Estimated blood loss was <200 ml. An MRI on day 13 still showed regular placental circulation, but after 4 weeks, perfusion and HCG levels had significantly decreased. The patient was examined every 3 days and readmitted after 6 weeks with a sudden rise of d-dimers. Within 24 hours, the complete placenta was delivered. On postoperative day 54, MRI confirmed uterine involution without a placental tissue.Conclusions: Delayed placental delivery in patients with abnormal placental invasion is a legitimate option to preserve fertility and possibly to reduce intrapartum hemorrhage.

Uterine rupture due to placenta percreta in the first trimester of a pregnancy subsequent to a transverse uterine fundal cesarean section: A case report

Transverse uterine fundal cesarean section in cases of total placenta previa reduces blood loss, but its influence on subsequent pregnancies, including the uterine rupture risk, remains unclear. We report a case of uterine rupture due to placenta percreta in the first trimester in a 43-year-old woman who underwent transverse uterine fundal incision in a previous pregnancy (at 40 years old). The patient did not undergo assessment of the uterine scare after the previous operation. Oocyte donation and in vitro fertilization at another institution resulted in the current pregnancy. At 11 weeks 3 days, she was admitted to the emergency department because of sudden severe abdominal pain. Ultrasound showed massive accumulation of free fluid in the peritoneal cavity and the fetus was outside the uterine cavity; uterine rupture was diagnosed. During emergency laparotomy, the uterine rupture was detected at exactly the previous incision site; a total hysterectomy was performed. Pregnancy after a transverse uterine fundal cesarean section is at high risk. As uterine scar dehiscence might have caused the uterine rupture, wounds should be evaluated before allowing subsequent pregnancies.