Spontaneous Uterine Rupture From Placenta Percreta

Abstract

INTRODUCTION: Placenta percreta is a known cause of life-threatening hemorrhage requiring peripartum hysterectomy but only rarely leads to spontaneous uterine rupture before viability. Few case reports exist in the literature, yet this may become a more common occurrence with increasing cesarean delivery rates. We report a series of six cases of placenta percreta during an 18-month period at our institution, of which three resulted in spontaneous uterine rupture before viability. METHODS: This was a retrospective chart review of all placenta percreta cases at a single tertiary care center between December 2011 and May 2013. Patient demographics, pregnancy history, clinical presentation, intraoperative findings, and pathology results were reviewed (Table 1). Statistical analysis was performed using the Student's t test.RESULTS: Three cases of spontaneous uterine rupture from placenta percreta occurred between 17 and 21 weeks of gestation. All three ruptured cases presented with abdominal pain of unclear etiology. One of the ruptured cases did not have suspected placenta accreta preoperatively. The mean number of prior cesarean deliveries was 2.3 for both ruptured (±1.2) and unruptured (±0.6) patients (P=.87). The mean estimated blood loss was higher for ruptured cases (7,500±500 mL), compared with unruptured cases (2,650±786 mL) (P<.001). Pathological examination confirmed the diagnosis of placenta percreta in all six cases. CONCLUSIONS: Given rising cesarean delivery rates, obstetricians should consider the possibility of placenta percreta resulting in spontaneous uterine rupture if a patient presents with abdominal pain with a history of prior cesarean deliveries and suspected abnormal placentation.