Placenta percreta presenting as uterine rupture following previous B-Lynch suture

2021 ◽  
Vol 14 (10) ◽  
pp. e245593
Author(s):  
Shubhashis Saha ◽  
Anuja Abraham ◽  
Preethi Raja Navaneethan ◽  
Kavitha Abraham
Keyword(s):  
Caesarean Section ◽  
Uterine Rupture ◽  
Stable Condition ◽  
Placenta Percreta ◽  
Intrauterine Fetal Death ◽  
Emergency Laparotomy ◽  
Caesarean Scar ◽  
Adherent Placenta ◽  
Invasive Placenta ◽  
Caesarean Hysterectomy

Placenta accreta spectrum disorder varies from minimally adherent placenta to deeply invasive placenta. Placenta percreta is a rare cause for uterine rupture and the incidence of morbidly adherent placenta is on the rise due to increase in the rates of caesarean section. We report a case of a 32-year-old, G2P1L1 who presented to us at 27 weeks in a state of haemodynamic shock with intrauterine fetal death. She had a history of prior caesarean section complicated by postpartum haemorrhage requiring B-Lynch suturing. With an initial diagnosis of caesarean scar rupture, she underwent an emergency laparotomy. Intraoperatively, the caesarean scar was found to be intact and uterine fundal rupture with placental protrusion identified. She underwent caesarean hysterectomy and was discharged in a stable condition. The histopathology report confirmed the diagnosis of placenta percreta.

scholarly journals Is it necessary to correct a caesarean scar defect before a subsequent pregnancy? A report of three cases

2019 ◽  
Vol 47 (5) ◽  
pp. 2248-2255
Author(s):  
Piotr Szkodziak ◽  
Anna Stępniak ◽  
Piotr Czuczwar ◽  
Filip Szkodziak ◽  
Tomasz Paszkowski ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Preterm Delivery ◽  
Uterine Rupture ◽  
Subsequent Pregnancy ◽  
Surgical Correction ◽  
The Other ◽  
Obstetric Outcome ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy ◽  
Caesarean Scar Defect

Rates of caesarean section have increased over recent years and so too have associated complications, one of which is a caesarean scar defect (CSD). The defect may cause gynaecological symptoms, such as menometrorrhagia, infertility, chronic abdominal/pelvic pain or it may be asymptomatic. The presence of CSD may lead to obstetrical sequalae such as preterm delivery, uterine rupture, caesarean scar pregnancy or abnormal placenta implantation. Three cases of CSD are described here. In one case, surgical correction of the CSD was performed before a subsequent pregnancy with an uncomplicated obstetric outcome. In the other two cases, surgical correction of the CSD was not performed and the pregnancies were complicated by caesarean scar dehiscence and caesarean scar pregnancy. We suggest that women with a CSD may benefit from surgical correction of the defect before becoming pregnant to reduce the likelihood of serious complications.

scholarly journals Uterine Rupture with Massive Late Postpartum Hemorrhage due to Placenta Percreta Left Partially In Situ

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Mehmet Coskun Salman ◽  
Pinar Calis ◽  
Ozgur Deren
Keyword(s):  
Uterine Rupture ◽  
Bladder Wall ◽  
Placental Tissue ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Wall ◽  
Placenta Percreta ◽  
Emergency Laparotomy ◽  
Life Threatening

Placental adhesive disorders involve the growth of placental tissue into or through the uterine wall. Among these disorders, placenta percreta is the rarest one. However, it may cause significant complications. This report aimed to report a neglected patient with placenta percreta who developed uterine rupture with life-threatening late postpartum intra-abdominal hemorrhage. On admission, the patient had acute abdomen with moderate abdominal distention and was subjected to emergency laparotomy. A full-thickness defect of the anterior uterine wall involving the hysterotomy site was seen. Placental tissues occupied both sides of the incision and posterior bladder wall was also invaded by placenta. Total abdominal hysterectomy with partial resection of the posterior bladder wall was performed.

scholarly journals Caesarean Scar Pregnancy - A Rare Case Report

2016 ◽  
Vol 27 (2) ◽  
pp. 83-86 ◽  
Author(s):  
Razia Sultana ◽  
Saiful Islam ◽  
Nurjahan
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Transvaginal Sonography ◽  
Emergency Laparotomy ◽  
Colour Doppler ◽  
Caesarean Scar ◽  
Incomplete Abortion ◽  
Rare Case Report ◽  
Life Threatening

Objective:The aim is to publish the case report of the rarely occurring and life threatening ectopic pregnancy developing in a Caesarean section scar causing uterine rupture.Methods and Results: This patient was diagnosed initially as a case of incomplete abortion. Other possible diagnoses were molar pregnancy, mass in the cervix. She was admitted in hospital for evacuation and curettage. During the procedure she developed severe pervaginal bleeding leading to hypovolumic shock. So decision was taken for emergency laparotomy. After opening the abdomen rupture was found in the lower uterine segment extending upto upper part of cervix. So hysterectomy was performed and histopathology confirmed the diagnosis of ectopic pregnancy that developed in a Caesarean section scar Analysis of the women’s obstetric history revealed that she had been previously operated because of breech presentation.Conclusion: Heightened awareness of the possibility of pregnancy in caesarean scar and early diagnosis by means of transvaginal sonography along with colour doppler can improve outcome and minimize the need for emergency extended surgeryBangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 83-86

scholarly journals Cesarean Scar Ectopic Pregnancy

2021 ◽  
Vol 11 (5) ◽  
pp. 358-361
Author(s):  
Sunil V. Jagtap ◽  
Nitin Kshirsagar ◽  
Ramnik Singh
Keyword(s):  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Uterine Rupture ◽  
Vaginal Bleeding ◽  
Hypovolemic Shock ◽  
Lower Uterine Segment ◽  
Caesarean Scar ◽  
Anterolateral Wall ◽  
History Of ◽  
Gestational Sac

Caesarean Scar Ectopic Pregnancy (CSEP) is one of the rarest forms of ectopic pregnancy. We present a 30 year female presented with 8 weeks of amenorrhea. Her obstetric history was G3P2D2. Her B HCG levels were >10,000 IU/L. She had history of previous 2 lower uterine segment Caesarean section. She was referred to our hospital in stage of severe hypovolemic shock related to vaginal bleeding. USG findings were suggestive of death of fetus of about 6 weeks 5 days. Gestational -sac at lower uterine segment Caesarean section scar level. Radiological diagnosis was? Scar pregnancy. On histopathology diagnosed as Caesarean scar ectopic pregnancy with area of rupture in anterolateral wall of lower uterine segment and upper cervix. The endometrium was unremarkable. We are presenting this case for its rarity, clinical radiological and histopathological findings. Key words: Scar ectopic pregnancy, Uterine rupture, Gestation, Caesarean section.

scholarly journals Placenta Percreta: An Unusual Etiology for Spontaneous Rupture of Uterus Near Term

2014 ◽  
Vol 6 (3) ◽  
pp. 180-182
Author(s):  
Anupam Varshney ◽  
Neerja LNU ◽  
Manju Varma ◽  
RK Thakral
Keyword(s):  
Pregnant Women ◽  
Uterine Rupture ◽  
Spontaneous Rupture ◽  
Placenta Percreta ◽  
Emergency Laparotomy ◽  
Lower Segment Cesarean Section ◽  
Spontaneous Uterine Rupture ◽  
History Of ◽  
Rupture Of Uterus ◽  
Near Term

ABSTRACT Uterine rupture is a life-threatening complication in pregnancy with an incidence of 0.07%, out of which 80% are spontaneous rupture. Placenta percreta is the rarest form of placental implantation abnormalities, with an incidence 1 in 2500 pregnant women.1,2 Spontaneous uterine rupture due to placenta percreta is very rare, with an incidence of 1 in 4,366 pregnant women.3 It often occurs in patients with a history of scar in the uterus.4 Placenta percreta-induced spontaneous uterine rupture at term with previous lower segment cesarean section (LSCS) is difficult to diagnose. A 25-year-old pregnant woman, with history of one incomplete abortion treated by dilatation and curettage followed by a vaginal delivery with stillbirth and one LSCS again with stillbirth at term, was admitted in the emergency ward with history of approx 9 months amenorrhea, breathlessness, pain in abdomen (unable to lie down or even sit), vomiting and loss of fetal movements for last 24 hours. O/E: GC fair, afebrile, Pallor +++, pedal edema +, pulse 100/minutes regular, resp. rate; 40/minutes, thoracic, BP 110/70 mm Hg, lung fields clear with no abnormality detected in heart. On P/A: skin was stretched and a Pfannensteil scar healed by primary intention was present Abdomen tense, tender therefore fundal height could not be assessed. Fetal parts were not palpable and lie/presentation could not be made out. FHS were absent. On P/V; os closed with uneffaced cervix, presenting part could not be made out and was high. No bleeding or leaking per-vaginum was present. Hb 6.7 gm%, TLC 15600, DLC P90, L8, E2, M0. Ultrasound done on 27.5.12 (one month back) outside revealed 32.3 weeks gestation with normal scar thickness, placenta located in upper segment, grade I. No comment was made on the interface between placenta and myometrium in ultrasound report. Patient was subjected to emergency laparotomy, massive hemoperitoneum was found. Examination of uterus revealed an intact previous scar. A full term male stillborn baby was delivered by uterine scar (LSCS) on 21.6.2012, at 10.30 pm The placenta could not be delivered as there was no plain of cleavage between placenta and myometrium. Uterus was exteriorized and to surprise there was a rent of about 3 × 2 cm at left cornua, placental tissue peeping out on removing the clots. Subtotal hysterectomy was performed. Three units blood were transfused. Postoperative period was uneventful and the patient was discharged in satisfactory condition on 9th day. Histopathological examination of the uterine specimen revealed placenta percreta. To conclude uterine rupture should be considered in the differential diagnosis in pregnant women who present with acute abdomen with or without shock. How to cite this article Neerja, Varma M, Thakral RK, Varshney A. Placenta Percreta: An Unusual Etiology for Spontaneous Rupture of Uterus Near Term. J South Asian Feder Obst Gynae 2014;6(3):180-182.

scholarly journals A Case of Placenta Percreta Managed with Sequential Embolisation Procedures

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Shannon Armstrong-Kempter ◽  
Supuni Kapurubandara ◽  
Brian Trudinger ◽  
Noel Young ◽  
Naim Arrage
Keyword(s):  
Placenta Percreta ◽  
Uterine Artery Embolisation ◽  
Safe Alternative ◽  
Placental Perfusion ◽  
Major Morbidity ◽  
Invasive Placenta ◽  
Management Modality ◽  
Caesarean Hysterectomy ◽  
Primary Management ◽  
Abnormally Invasive Placenta

Background. The incidence of morbidly adherent placenta, including placenta percreta, has increased significantly over recent years due to rising caesarean section rates. Historically, abnormally invasive placenta has been managed with caesarean hysterectomy; however nonsurgical interventions such as uterine artery embolisation (UAE) are emerging as safe alternative management techniques. UAE can be utilised to decrease placental perfusion and encourage placental resorption, thereby reducing the risk of haemorrhage and other morbidities. Case. We describe one of the very few reported cases of placenta percreta which was successfully treated primarily with sequential artery embolisation. Our patient underwent four embolisation procedures over a period of 248 days, with no major morbidity or complications. Conclusion. Repeat UAE may be a beneficial primary management modality in cases of placenta percreta with bladder involvement.

scholarly journals CAESAREAN SCAR PREGNANCY;

2013 ◽  
Vol 20 (05) ◽  
pp. 849-851
Author(s):  
RAZIA SULTANA ◽  
SAIF-UL- ISLAM ◽  
NURJAHAN -
Keyword(s):  
Uterine Rupture ◽  
Operative Procedure ◽  
Fibrous Tissue ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Massive Hemorrhage ◽  
Emergency Laparotomy ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy ◽  
Profuse Hemorrhage

Caesarean Scar pregnancy (CSP) is a rare form of Ectopic pregnancy where the gestation sac is surrounded bymyometrium and the fibrous tissue of the scar from the previous caesarean section. It is often misdiagnosed as Molar pregnancy orInevitable Abortion and can be associated with massive hemorrhage and pervaginal bleeding leading to uterine rupture. Here we reporteda case of Caesarean scar pregnancy who presented with history of cesarean section and pervaginal bleeding. Dilatation and curettagewas planned but during the operative procedure there was profuse hemorrhage leading to hypovolumic shock which was managed byBlood and venesection then emergency laparotomy followed by Total Abdominal Hysterectomy done as life saving procedure,th postoperative period was uneventful and the patient was discharged on 10 postoperative day. Diagnosis is important as caesarean scarpregnancy is associated with life threatening complications such as uterine rupture, massive hemorrhage and the need for Hysterectomywith subsequent loss of fertility.

scholarly journals An observational study of uterine rupture at a tertiary care center

2021 ◽  
Vol 10 (11) ◽  
pp. 4244
Author(s):  
Sangeeta Tvinwal ◽  
Pooja Meena ◽  
Bharat Bhushan Bamaniya
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Uterine Rupture ◽  
Death Rate ◽  
Perinatal Death ◽  
Care Center ◽  
Tertiary Care ◽  
Emergency Laparotomy ◽  
Maternal Complications ◽  
Increased Risk

Background: Uterine rupture is one of the most dangerous obstetric emergency situation carrying an increased risk of maternal and perinatal morbidity and mortality. This catastrophic complication occurs most often in women attempting a vaginal birth after a prior LSCS. Aim was to determine the incidence, etiology, management, maternal and fetal outcome. Recommend strategy for its prevention to reduce the incidence of maternal and fetal morbidity and mortality.Methods: This prospective observational study was conducted over a period of 1 year. Total 51 cases who were diagnosed with rupture were included in the study. Emergency laparotomy after pre-operative resuscitation done. Hysterectomy or repair of rupture site was done depending on the condition of the patient, parity, presence or absence of infection.Results: Maximum patients of uterine rupture belonged to 37-40 weeks of GA. Inter-delivery interval <18-24 week were more vulnerable. Patients with previous caesarean section was more than without section. Maximum cases presented with signs of shock. Maternal death rate was 11.63%, whereas perinatal death rate was 82.35%.Conclusions:Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors are: history of prior caesarean section, grand multiparity, obstructed labor, and fetal malpresentations. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse feto-maternal complications. 

scholarly journals One step conservative surgery: an approach to manage placenta accreta spectrum

2021 ◽  
Vol 10 (7) ◽  
pp. 2884
Author(s):  
Soniya Dahiya ◽  
Pushpa Dahiya ◽  
Shweta Jain ◽  
Sunita .
Keyword(s):  
Caesarean Section ◽  
Postpartum Hemorrhage ◽  
Placenta Accreta ◽  
Caesarean Section Rate ◽  
Conservative Surgery ◽  
Emergency Laparotomy ◽  
One Step ◽  
Placenta Accreta Spectrum ◽  
Labour Room ◽  
Caesarean Hysterectomy

The incidence of placenta accreta spectrum (PAS) has been arisen over past few decade, attributed to increasing caesarean section rate from 1:2500 to 1:500. Caesarean hysterectomy cases are increasing to prevent morbidity and mortality in PAS. The conservative approach for PAS is to prevent postpartum hemorrhage and to preserve the uterus. We present a case of placenta accreta spectrum where we had done one step conservative surgery. A 35year old woman G3P2A0 with 32 weeks of twin pregnancy with previous caesarean section with complaints of premature rupture of membrane was admitted in emergency labour room. Patient went into preterm labour on third day of admission and delivered two live preterm babies. Placenta could not be removed after delivery. Manual removal of placenta was tried but placenta could not be removed completely and bleeding was excessive after the procedure. Medical management of postpartum hemorrhage was done. On local examination there was no cervico-vaginal tear and laceration, upper segment of uterus appeared to be well contracted, lower segment ballooned up and bleeding was still excessive. Decision of emergency laparotomy was taken. Patient underwent emergency laparotomy for postpartum hemorrhage followed by segmental resection of invaded area, bleeding stop. Post operative period is uneventful.In young and low parity patient, one step conservative surgery can be considered a uterine preserving approach in the absence of placenta praevia.

scholarly journals Placenta percreta complicated by uterine rupture and thrombotic microangiopathy

2018 ◽  
Vol 25 (2) ◽  
pp. 61-65
Author(s):  
Dalia Laužikienė ◽  
Saulius Vosylius ◽  
Ieva Šiaudinytė ◽  
Emilis Laužikas ◽  
Diana Ramašauskaitė ◽  
...  
Keyword(s):  
Thrombotic Microangiopathy ◽  
Uterine Rupture ◽  
Lower Abdominal Pain ◽  
Kidney Injury ◽  
Good Health ◽  
Placenta Percreta ◽  
Medical Documentation ◽  
Blood Component ◽  
Caesarean Scar ◽  
Life Threatening

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.

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