Spontaneous uterine rupture due to cornual placenta percreta in unscarred uterus: A rare & challenging case

Abstract

Spontaneous uterine rupture in unscarred uterus is a rare and catastrophic complication of pregnancy which can occur at any stage. The placental implantation at cornual end leading to placenta percreta, least common type of placenta accreta syndrome which causes uterine rupture in this case. Placenta accreta is defined as the abnormal attachment or invasion of the whole placenta or parts of it to the underlying musculature. It is a rare clinical condition with incidence ranging from 1: 500 to 1: 93000 deliveries. It is potentially life-threatening for both the mother and the fetus. Adherent placenta accounts for 7-10% of maternal mortality cases worldwide. Prenatal diagnosis seems to be a key factor in optimizing maternal outcome. Both ultrasonography & MRI have good sensitivity for prenatal diagnosis of placenta accreta. In this report we present the case of a G3P1011 with no known risk factors for adherent placenta who was diagnosed to have uterine rupture due to placenta percreta at cornual end leading to haemorrhagic shock. There was gross haemoperitoneum with evidence of uterine rupture on exploratoration which further proceeded with caesarean section & peripartum hysterectomy. Her postoperative period was uneventful. This case report emphasis the importance of keeping spontaneous uterine rupture due placenta percreta in the differential diagnosis of pregnant patient presenting with pain abdomen, hypovolumic shock and intrauterine death even in unscarred uterus.