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Kamal Mohamed A, Awadalla S, Nawaz A. It Is Not Always an Ectopic or Heterotopic Pregnancy. Cureus 2023; 15:e37083. [PMID: 37153280 PMCID: PMC10156437 DOI: 10.7759/cureus.37083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Uterine rupture is a life-threatening peripartum complication. Spontaneous uterine rupture in early pregnancy is very rare. The diagnosis of uterine rupture should be considered when a pregnant patient presents with an acute abdomen because its clinical signs in early pregnancy are non-specific and the differentiation with other acute abdominal emergencies is challenging. Here, we present a case of acute abdominal pain. The patient was a 14-week pregnant 39-year-old female (gravida 4, para 2+1) with a history of two lower-segment cesarean sections. Our preoperative diagnosis was either heterotopic pregnancy or acute abdomen. Emergency laparotomy confirmed the presence of a spontaneous uterine rupture.
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Fahrni AC, Salomon D, Zitiello A, Feki A, Ali NB. Recurrence of a second-trimester uterine rupture in the fundus distant from old scars: A case report and review of the literature. Case Rep Womens Health 2020; 28:e00249. [PMID: 32884909 PMCID: PMC7451669 DOI: 10.1016/j.crwh.2020.e00249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022] Open
Abstract
Uterine rupture is a rare event which can have severe obstetric consequences and most often occurs on a scarred uterus at the site of the scar. However, a uterine rupture can appear at another location. We report the case of a woman with a previous emergency caesarean section for spontaneous posterior uterine rupture which recurred at another site during her second pregnancy. She was admitted to the emergency room with acute abdominal pain and development of a pre-shock hemorrhagic state. Abdominal ultrasound showed abundant peritoneal fluid and a fetus without cardiac activity in an intact bulging amniotic fluid membrane. We performed an emergency laparotomy, which confirmed an intact amniotic sac in the abdominal cavity and showed a 7 cm transverse fundal uterine rupture beginning at the right angle, distant from the old known scars. In view of the high maternal and fetal morbidity, obstetricians should have a high suspicion of an antepartum uterine rupture, even at an early gestational age, in the event of acute abdominal pain over a scarred uterus. Exceptional case of a second uterine rupture in the second trimester distant from old scars. Spontaneous uterine rupture in the second trimester is associated with a higher maternal-fetal morbidity. The most common site of spontaneous uterine rupture which did not occur during labor is the fundus.
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Fonseca A, Ayres de Campos D. Maternal morbidity and mortality due to placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol 2020; 72:84-91. [PMID: 32778495 DOI: 10.1016/j.bpobgyn.2020.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Abstract
Placenta accreta spectrum (PAS) disorders are an increasing health problem in many parts of the world. They are an important risk factor for adverse maternal outcomes related to delivery, with a reported 18-fold increase in maternal morbidity. Profuse haemorrhage after attempting to remove the placenta is the most frequent complication and can lead to major maternal morbidity and ultimately to maternal death. Morbidity can also arise from the multiple procedures required to treat PAS disorders. Intensive care unit admission, mechanical ventilation, infection, and prolonged hospitalization are common in these patients. Long-term complications related to infertility and psychological disturbances can also occur and may have a strong and long-lasting impact on women's health. Antenatal diagnosis allows for appropriate scheduling of delivery and referral to a specialized centre and has been shown to reduce maternal morbidity and mortality.
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Affiliation(s)
- Andreia Fonseca
- Department of Obstetrics, Santa Maria University Hospital, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal.
| | - Diogo Ayres de Campos
- Department of Obstetrics, Santa Maria University Hospital, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal; Medical School, University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
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Atypical presentation of hemorrhagic shock in pregnancy: a case highlighting the developing field of emergency medicine in Israel. BMC Emerg Med 2019; 19:70. [PMID: 31752688 PMCID: PMC6868723 DOI: 10.1186/s12873-019-0272-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occult hemorrhagic shock secondary to uterine rupture represents a true obstetric emergency and can result in significant morbidity and mortality for both the patient and the fetus. Multiparity and prior cesarean sections are known risk factors. Typically, these patients present late in gestation, often secondary to the physiologic stresses on the uterus related to contractions. This pathology is less common earlier in pregnancy and can often be overlooked in the acute setting. CASE PRESENTATION We present the case of a 31-year-old female with three prior gestations, two parities and two prior cesarean sections, resulting in three live births, who presented to the Emergency Department (ED) 22-weeks pregnant with acute onset dyspnea and an episode of syncope. Due to her altered mental status there was concern for occult shock, despite normal vital signs. Large amounts of free fluid in the abdomen were noted on bedside ultrasonography with a high suspicion for uterine pathology. She was resuscitated with blood and taken immediately to the operating room for surgical management where she was found to have had a uterine rupture. CONCLUSION This case highlights a rare presentation of a well-known obstetric emergency, due to the patient's development of uterine rupture early in gestation. Consequently, emergency physicians should consider atraumatic hypovolemic shock, secondary to this obstetric catastrophe, even at a stage that far precedes its expected presentation. In addition, we make note of how this case validated our department's integrated emergency medicine model, the first in the State of Israel.
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Enebe JT, Ofor IJ, Okafor II. Placenta percreta causing spontaneous uterine rupture and intrauterine fetal death in an unscared uterus: A case report. Int J Surg Case Rep 2019; 65:65-68. [PMID: 31689631 PMCID: PMC6838971 DOI: 10.1016/j.ijscr.2019.10.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Placenta percreta is a rare; a life-threatening disorder of placentation and one of the components of the placenta accreta spectrum. It can lead to uterine rupture, an obstetric catastrophe that can be associated with increased maternal and fetal morbidity and mortality. PRESENTATION OF CASE We present an unusual case of spontaneous uterine rupture due to placenta percreta in an unscarred uterus of a multiparous woman leading to spontaneous intrauterine fetal death. She presented with hypovolaemic shock following spontaneous rupture of the uterus and subsequent intra-peritoneal bleeding. DISCUSSION Uterine rupture occurs commonly in a scarred uterus from some form of trauma or injudicious use of oxytocics. However, uterine rupture occurring in the absence of prior scar or use of oxytocics is a rarity. Placenta percreta is an unusual cause of uterine rupture and subsequent intra-uterine fetal death. Placenta percreta occurs when the uterine wall is invaded by the placenta up to the level of the serosa. A high index of suspicion and thorough review of the patient is required for making this diagnosis. Misdiagnosis is associated with dare consequences of increased maternal morbidity and mortality. CONCLUSION Placenta percreta is a rare disorder of placentation that can cause uterine rupture which can easily be misdiagnosed. Prompt diagnosis and institution of the appropriate care can help prevent catastrophic outcomes as demonstrated in the case reported.
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Affiliation(s)
- J T Enebe
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology College of Medicine/Teaching Hospital, Parklane, Enugu, Nigeria.
| | - I J Ofor
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Nigeria
| | - I I Okafor
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology College of Medicine/Teaching Hospital, Parklane, Enugu, Nigeria
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Hysterectomy with Fetus In Situ for Uterine Rupture at 21-Week Gestation due to a Morbidly Adherent Placenta. Case Rep Obstet Gynecol 2018; 2018:5430591. [PMID: 30245897 PMCID: PMC6139238 DOI: 10.1155/2018/5430591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/23/2018] [Accepted: 08/15/2018] [Indexed: 11/26/2022] Open
Abstract
Background Uterine rupture due to a morbidly adherent placenta is a rare obstetrical cause of acute abdominal pain in the pregnant patient. We present a case to add to the small body of published literature describing this diagnosis. Case A 32-year-old G5T2P1A1L2 with multiple prior cesarean sections presented at 21+3 weeks' gestation with abdominal pain and presyncope. Ultrasound showed a large volume of complex intraabdominal free fluid and a heterogenous placenta with irregular lacunae and increased vascularity extending to the posterior bladder wall. Exploratory laparotomy identified a uterine defect and a hysterectomy was performed due to significant bleeding. Pathology confirmed a diagnosis of placenta percreta. Conclusion Early recognition and management of uterine rupture due to a morbidly adherent placenta are essential to prevent catastrophic hemorrhage.
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Serrano Diana C, Díaz Serrano MD, Arenas Gomez B, Gómez García MT, Martinez Carrasco AM, Amezcua Recover AN, Gonzalez de Merlo G. Spontaneous uterine rupture at 19 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2017; 217:183-184. [PMID: 28911796 DOI: 10.1016/j.ejogrb.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Affiliation(s)
- C Serrano Diana
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain.
| | - M D Díaz Serrano
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain
| | - B Arenas Gomez
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain
| | - M T Gómez García
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain; Department of Medical Sciences, School of Medicine of Albacete, University of Castilla-La Mancha, Spain
| | - A M Martinez Carrasco
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain
| | - A N Amezcua Recover
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain; Department of Medical Sciences, School of Medicine of Albacete, University of Castilla-La Mancha, Spain
| | - G Gonzalez de Merlo
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain; Department of Medical Sciences, School of Medicine of Albacete, University of Castilla-La Mancha, Spain
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Tuştaş Haberal E, Çekmez Y, Ulu İ, Divlek R, Göçmen A. Placenta percreta with concomitant uterine didelphys at 18 weeks of pregnancy: a case report and review of the literature. J Matern Fetal Neonatal Med 2015; 29:3445-8. [PMID: 26653847 DOI: 10.3109/14767058.2015.1130819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this paper is to draw the attention of the clinicians on placenta percreta detected along with uterine anomalies in early second trimester. CASE PRESENTATION A 35-year-old, gravida 2 parity 1 woman at 18 weeks of pregnancy was admitted to our emergency unit with abdominal pain. In ultrasound exam, a live fetus compatible with 18 weeks of gestation, hemoperitoneum and a solid mass adjacent to the uterus were detected. An emergent laparotomy was decided because of hemorrhagic shock findings. In the operation, uterine didelphys and an active bleeding area from placenta percreta on the anterior wall of the uterus where pregnancy was settled were detected. In the simultaneous vaginal examination two cervixes and a longitudinal vaginal septum were seen. Supracervical hemihysterectomy was performed. CONCLUSION Placenta percreta is a rare clinical entity with an elevated perinatal mortality. Uterine anomalies are risk factors for placental adhesion anomalies. Clinical suspicion is vital for early diagnosis and timely management.
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Affiliation(s)
- Esra Tuştaş Haberal
- a Department of Obstetrics and Gyneacology , Ümraniye Medical and Research Hospital , İstanbul , Turkey
| | - Yasemin Çekmez
- a Department of Obstetrics and Gyneacology , Ümraniye Medical and Research Hospital , İstanbul , Turkey
| | - İpek Ulu
- a Department of Obstetrics and Gyneacology , Ümraniye Medical and Research Hospital , İstanbul , Turkey
| | - Radia Divlek
- a Department of Obstetrics and Gyneacology , Ümraniye Medical and Research Hospital , İstanbul , Turkey
| | - Ahmet Göçmen
- a Department of Obstetrics and Gyneacology , Ümraniye Medical and Research Hospital , İstanbul , Turkey
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Kayem G, Deneux-Tharaux C, Sentilhes L. PACCRETA: Clinical situations at high risk of Placenta ACCRETA/Percreta: impact of diagnostic methods and management on maternal morbidity. Acta Obstet Gynecol Scand 2013; 92:476-82. [DOI: 10.1111/aogs.12078] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 01/09/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | - Catherine Deneux-Tharaux
- INSERM Unit 953; Epidemiological Research Unit on Perinatal Health and Women's and Children's Health; Hospital Saint-Vincent de Paul; Paris
| | - Loic Sentilhes
- Department of Obstetrics and Gynecology; Angers University Hospital; Angers; France
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Sun HD, Su WH, Chang WH, Wen L, Huang BS, Wang PH. Rupture of a pregnant unscarred uterus in an early secondary trimester: a case report and brief review. J Obstet Gynaecol Res 2012; 38:442-5. [PMID: 22229814 DOI: 10.1111/j.1447-0756.2011.01723.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rupture of a pregnant uterus in early pregnancy and an unscarred uterus are extremely rare, and some non-specific symptoms might appear before this occurrence. We report the case of a multiparous woman (gravida 3, para 2) with uterine fundal rupture in her early second trimester (17+ weeks of gestational age), who presented upper abdominal discomfort and vomiting for 3 days, and progressed into sudden acute abdomen and shock. During emergent laparotomy, the entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Although we could not confirm that the appearance of upper gastrointestinal symptoms and severe vomiting was associated with uterine rupture in this pregnant woman, abdominal symptoms or signs might be a hint or cause of severe catastrophic pregnancy-related complications.
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Affiliation(s)
- Hsu-Dong Sun
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Ban Ciao, New Taipei City, Taiwan
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An unusual case of hemoperitoneum: uterine rupture at 9 weeks gestational age. J Emerg Med 2007; 33:285-7. [PMID: 17976559 DOI: 10.1016/j.jemermed.2007.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 01/22/2007] [Accepted: 01/24/2007] [Indexed: 11/20/2022]
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Kayem G, Grangé G, Goffinet F. Prise en charge du placenta accreta. ACTA ACUST UNITED AC 2007; 35:186-92. [PMID: 17317266 DOI: 10.1016/j.gyobfe.2007.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 01/19/2007] [Indexed: 11/23/2022]
Abstract
Placenta accreta occurs when a defect of the decidua basalis results in abnormally invasive placental implantation. Main risk factors include placenta previa and previous caesarean section. The conventional sonographic criteria for abnormally adherent placenta have a good diagnostic value that has to be assessed. MRI should improve the diagnosis when sonography is inconclusive. The choice of the treatment results of medical staff and the women's choice. It implies centers with adequate equipment and resources. Radical strategy consists in caesarean hysterectomy according to American recommendations or in an attempt of complete placental delivery associated with trial haemostasis and hysterectomy if this fails. A conservative approach whereby the placenta is left in place may however be proposed in selected cases if the woman wishes to continue to be fertile. This strategy needs a rigorous follow-up until complete resorption of the placenta. In case of major hemorrhage, hysterectomy should not be delayed to prevent major maternal complications or even maternal death.
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Affiliation(s)
- G Kayem
- Service de Gynécologie-Obstétrique, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
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