Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: A case report

Le Ming Wang, Peng Hui Wang, Chi-Long Chen, Heng-Kien Au, Yuan Kuei Yen, Wei-Min Liu

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Several cases in which uteruses have been preserved in women with placenta percreta have been reported. We herein report a 38-year-old woman with a history of previous cesarean section who was admitted with lower abdominal pain and vaginal bleeding at 31 weeks of gestation. An urgent exploratory laparotomy revealed active bleeding from the uterine rupture on the posterior uterine wall. A female infant weighing 1560 g, with Apgar scores of 1, 1, and 3 at 1, 5, and 10 min, respectively, was delivered, and the placenta was removed. We performed bilateral uterine vessel occlusion, followed by wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, and an intramuscular injection of 0.2 mg methylergonovine, primary repair of the defect, and an additional 24-h postoperative oxytocin infusion (30 IU in 5% dextrose 500 mL) to preserve the uterus successfully. Although the overall blood loss was 3700 mL, no disseminated intravascular coagulopathy occurred after the patient had received adequate blood transfusion. The postoperative pathological diagnosis was placenta percreta with uterine rupture. The patient and her baby were discharged uneventfully. In some cases of spontaneous uterine rupture secondary to placenta percreta, we can preserve the uterus by performing bilateral uterine vessel occlusion and wedge resection of the ruptured uterine wall.

Original languageEnglish
Pages (from-to)379-384
Number of pages6
JournalJournal of Obstetrics and Gynaecology Research
Volume35
Issue number2
DOIs
Publication statusPublished - Apr 2009

Keywords

  • Cesarean section
  • Fertility preservation
  • Placenta percreta
  • Uterine rupture

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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