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Title: Uterine rupture due to placenta percreta at 13/40 gestation resulting in hysterectomy.
Authors: Stubna, Chantelle
Frawley, Natasha
Kumarage, Iruka
Issue Date: 2015
Conference Name: RCOG World Congress 2015
Conference Date: April 12-15, 2015
Conference Place: Brisbane, Queensland
Abstract: Introduction Uterine rupture due to placenta percreta is a rare diagnosis. Reviewing the literature, it mainly occurs in the second and third trimesters but has also been reported to occur as early as 9/40. Risk factors for uterine rupture in pregnancy include previous caesarean section (CS), placenta praevia, multiparity and advanced maternal age. Uterine rupture as a result of placenta percreta carries high morbidity from haemorrhage due to increased vascularisation at the rupture point and can be more dangerous than rupture from a previous CS scar opening alone. There are case reports of conservative management including curettage, packing, methotrexate treatment, bilateral uterine artery occlusion and primary closure of the defect. However, given the high morbidity/mortality associated with uterine rupture, hysterectomy is usually preferred in controlling life threatening haemorrhage. Case A 26-year-old G3P1 at 13 + 5/40 gestation presented to our Emergency Department (ED) with sudden onset right iliac fossa (RIF) pain radiating to her shoulders. Past history included an emergency CS 1 year prior for fetal distress at 2 cm dilatation at 39 weeks and a spontaneous first trimester miscarriage. The index pregnancy had been complicated by vaginal bleeding but transvaginal ultrasound scans (TV USS) at 10 and 12 weeks had shown a live intrauterine pregnancy (IUP) and normal adnexae. On examination the patient appeared unwell but vital signs were normal. There were signs of peritonism in the RIF. Cervical excitation and right adnexal tenderness were present on vaginal examination. Haemoglobin was 11.5 g/dL. TV USS showed free fluid in the pelvis and a live IUP. The patient deteriorated whilst being managed in ED and was rushed to theatre following resuscitation. Laparoscopy revealed a massive haemoperitoneum with ongoing profuse bleeding and laparotomy was performed. A ruptured uterus with placenta extruding through the anterior wall was identified as the bleeding point. The fetus was delivered via hysterotomy in an attempt to salvage the uterus. Profuse bleeding continued despite removal of the placenta and the patient was unstable. A hysterectomy was performed promptly. Estimated blood loss was over 3.5 L. Ten units of blood, ten units of cryoprecipitate, one bag of platelets and four units of fresh frozen plasma were transfused. The patient recovered well. Histopathology confirmed placenta percreta. Conclusion An acute abdomen in pregnancy should have uterine rupture from placenta percreta considered as a differential diagnosis, even in the first trimester.
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Internal ID Number: 00658
Type: Conference
Appears in Collections:Research Output

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