Uterine rupture secondary to placenta percreta in a near-term pregnant woman with a history of hysterotomy

Ching Hui Chen, Peng Hui Wang, Jui Yu Lin, Yen Hsieh Chiu, Hong Ming Wu, Wei-Min Liu

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Uterine rupture during near-term pregnancy is a life-threatening condition. A 31-year-old pregnant woman with a breech presentation at the gestation age of 35 +2 weeks had complained of a dull abdominal pain for days. She was treated 2 years ago with bilateral uterine artery ligation and hysterotomy for removal of the retained placenta. An aggravation of abdominal pain occurred suddenly 4 h after hospitalization. The cardiotocogram showed a fetal heart beat with loss of variability, but increasing deceleration. An urgent cesarean section was performed because of suspected placenta abruption. After successful delivery of the fetus, a protruding placental tissue was found on the fundal uterine wall. We performed 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, an intramuscular injection of 0.2 mg methylergonovine, and primary repair of the defect, but in vain. Cesarean hysterectomy was used to control the intractable bleeding. The accumulated blood loss was more than 10 000 mL. The final pathology confirmed placenta percreta with uterine rupture. Luckily, both mother and fetus recovered well and were discharged 7 days later. We concluded that women with retained placenta and/or postpartum hemorrhage managed by previous hysterotomy and uterine artery ligation still need careful prenatal care, since the possibility of re-occurrence of the placenta percreta is easily overlooked and may result in a further life-threatening situation, such as the uterine rupture in this case.

Original languageEnglish
Pages (from-to)71-74
Number of pages4
JournalJournal of Obstetrics and Gynaecology Research
Volume37
Issue number1
DOIs
Publication statusPublished - Jan 2011

Keywords

  • Cesarean hysterectomy
  • Hysterotomy
  • Placental percreta
  • Scarred uterus
  • Uterine rupture
  • Uterine vessel occlusion

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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