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Spontaneous rupture of a primigravid uterus secondary to placenta percreta. A case report.

Abstract

BACKGROUND
Uterine rupture secondary to placenta percreta has been observed in multiparous patients. These cases are typically associated with a prior history of uterine trauma or infection: hysterotomy, myomectomy, cornual resection, dilatation and curettage, manual removal of the placenta or endometritis. Spontaneous rupture of the primigravid uterus without a history of trauma or infection is an exceedingly rare occurrence. This case represents the second reported in the medical literature and the first to result in a live-born infant.
CASE
A 23-year-old, African American primigravida at 26 weeks' gestation presented with acute-onset abdominal pain, severe hypotension, tachycardia and fetal heart rate decelerations. Blood product replacement was initiated, and an emergency laparotomy was performed for a presumptive diagnosis of intraabdominal hemorrhage. A significant hemoperitoneum was encountered, with the fetus floating freely in the peritoneal cavity. The uterus had a fundal rupture with a clinically apparent placenta percreta that necessitated performing a total abdominal hysterectomy. The patient recovered uneventfully, and the infant survived without significant morbidity.
CONCLUSION
Spontaneous rupture of the primigravid uterus can occur in the absence of a history of uterine trauma or infection. If a gravid woman presents with hypotension, abdominal pain and fetal distress, the differential diagnosis should include rupture of the uterus, regardless of parity or gynecologic history. Rapid diagnosis, blood product replacement and emergency laparotomy are the key steps in successful management.

Authors

Imseis HM, Murtha AP, Alexander KA, Barnett BD

Source

The Journal of reproductive medicine 43:3 1998 Mar pg 233-6

MeSH

Abdominal Pain
Adult
Diagnosis, Differential
Female
Heart Rate, Fetal
Humans
Hypotension
Parity
Placenta Accreta
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, Second
Uterine Rupture

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

9564654