Abstract
Background.Uterine rupture at the site of a previous caesarean scar with abnormal placental penetration through the uterus wall with bladder invasion is a rare and serious pregnancy complication. Our aim was to report a case of uterine rupture with placenta percreta complicated by thrombotic microangiopathy.Materials and methods.We did a literature review and analysed medical documentation retrospectively.Results.A patient was admitted with complaints of lower abdominal pain at 21 weeks of gestation. Sonography of the caesarean scar increased suspicion of placental penetration. Anaemia, thrombocytopenia, coagulopathy, and acute kidney injury developed and led to the diagnosis of thrombotic microangiopathy. The termination of pregnancy was required due to severe deterioration in organ functions. The complete uterine rupture with placenta percreta invading the urinary bladder was confirmed, and total hysterectomy was performed to control life-threatening haemorrhage. The patient was treated by blood component transfusions, renal replacement therapy, and plasmapheresis. Good health was confirmed two months later by laboratory and instrumental tests.Conclusions.It is a rare but very serious condition that increases morbidity of mother and foetus, therefore immediate diagnostics and treatment are required.
Highlights
The growing frequency of caesarean deliveries leads to a dramatically increasing rate of morbidly adherent placenta
The patient did not have any complaints: laboratory and instrumental tests showed normal renal function and confirmed uneventful recovery. This case report presents an uncommon combination of a complete uterine rupture and placenta percreta with bladder invasion complicated by thrombotic microangiopathy in the second trimester of pregnancy
Placenta percreta is a rare form of morbidly adherent placenta with penetration through the myometrium reaching serosa and even adjacent pelvic organs
Summary
The growing frequency of caesarean deliveries leads to a dramatically increasing rate of morbidly adherent placenta. A pregnancy complicated by both placenta percreta and thrombotic microangiopathy has not been previously reported. Case report A 35-year-old woman, unaccompanied by any body, was admitted to the hospital after loss of consciousness. She was confused and disorientated, and complained of abdominal pain. The patient denied violence, use of alcohol, drugs, and any medication. She was at 21 weeks of gestation with a history of prior two vaginal and four caesarean deliveries, three surgical abortions, and uterine perforation during the last abortion. Our aim was to report a case of uterine rupture with placenta percreta complicated by thrombotic microangiopathy
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