Abstract
IntroductionPlacenta increta is a serious complication of pregnancy. We describe a case leading to uterine rupture associated with massive intra-abdominal hemorrhage.Case presentationA 34-year-old Caucasian Albanian woman, gravida 2, para 1, was admitted to the emergency department of our hospital for acute abdominal pain associated with profound secondary anemia. An anatomopathological diagnosis of placenta increta destruens was made. An urgent hysterectomy was performed after resuscitation procedures, applied due to the severe anemia and the abdominal drama accompanying the case. Intra-operatively, a uterus-saving procedure was found to be impossible, and hysterectomy remained the only surgical option. The uterine structures were sent for further microscopic evaluation. On histological examination, deep trophoblastic infiltration of the uterine wall was observed, justifying the surgeon's decision. Our patient received blood transfusions and antibiotics. Her sutures were removed on the eighth postoperative day and she was discharged the following day in a stable condition.ConclusionThis case, describing a patient with uterine rupture and massive hemorrhage, illustrates a serious and potentially fatal complication of placenta previa. In such cases, surgery is essential, and hysterectomy may be the only viable option.
Highlights
Placenta increta is a serious complication of pregnancy
It is characterized by entire or partial absence of the decidua basalis, and by the incomplete development of the fibrinoid (Nitabuch’s) layer. It is considered a rare occurrence with a prevalence of approximately 1 in 2500-7000, it is associated with high morbidity and sometimes with a lethal outcome, mainly as a result of severe bleeding, uterine rupture and infections [1]
Correlations have been suggested with placenta previa, previous uterine curettage, previous cesarean sections, multiparity, and advanced maternal age [2]
Summary
Placenta increta is a serious complication of pregnancy It is characterized by entire or partial absence of the decidua basalis, and by the incomplete development of the fibrinoid (Nitabuch’s) layer. Case presentation A 34-year-old Caucasian Albanian woman was admitted during the 26th week of her second pregnancy for severe anemia and diffuse abdominal pain, and with the suspicion of uterine rupture. She had given birth 14 years previously to a healthy child by caesarean section. Because the quantity of intra-abdominal blood removed was considerable and the uterine rupture was considered sufficiently large to prevent a uterus-saving procedure, the surgeon opted not to use an arterial ligature. The sutures were removed on the eighth postoperative day, and she was discharged the day in a stable situation
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