Document Detail

Uterine rupture secondary to placenta percreta in a near-term pregnant woman with a history of hysterotomy.
MedLine Citation:
PMID:  21083836     Owner:  NLM     Status:  MEDLINE    
Uterine rupture during near-term pregnancy is a life-threatening condition. A 31-year-old pregnant woman with a breech presentation at the gestation age of 35(+2) weeks had complained of a dull abdominal pain for days. She was treated 2 years ago with bilateral uterine artery ligation and hysterotomy for removal of the retained placenta. An aggravation of abdominal pain occurred suddenly 4 h after hospitalization. The cardiotocogram showed a fetal heart beat with loss of variability, but increasing deceleration. An urgent cesarean section was performed because of suspected placenta abruption. After successful delivery of the fetus, a protruding placental tissue was found on the fundal uterine wall. We performed wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, an intramuscular injection of 0.2 mg methylergonovine, and primary repair of the defect, but in vain. Cesarean hysterectomy was used to control the intractable bleeding. The accumulated blood loss was more than 10,000 mL. The final pathology confirmed placenta percreta with uterine rupture. Luckily, both mother and fetus recovered well and were discharged 7 days later. We concluded that women with retained placenta and/or postpartum hemorrhage managed by previous hysterotomy and uterine artery ligation still need careful prenatal care, since the possibility of re-occurrence of the placenta percreta is easily overlooked and may result in a further life-threatening situation, such as the uterine rupture in this case.
Ching-Hui Chen; Peng-Hui Wang; Jui-Yu Lin; Yen-Hsieh Chiu; Hong-Ming Wu; Wei-Min Liu
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-11-18
Journal Detail:
Title:  The journal of obstetrics and gynaecology research     Volume:  37     ISSN:  1447-0756     ISO Abbreviation:  J. Obstet. Gynaecol. Res.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-06     Completed Date:  2011-05-20     Revised Date:  2012-01-19    
Medline Journal Info:
Nlm Unique ID:  9612761     Medline TA:  J Obstet Gynaecol Res     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  71-4     Citation Subset:  IM    
Copyright Information:
© 2010 The Authors. Journal of Obstetrics and Gynaecology Research © 2010 Japan Society of Obstetrics and Gynecology.
Department of Obstetrics and Gynecology, Taipei Medical University and Taipei Medical University Hospital, Taipei, Taiwan.
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MeSH Terms
Hysterotomy* / adverse effects
Placenta Accreta / physiopathology*
Pregnancy Outcome
Pregnancy Trimester, Third
Uterine Rupture / etiology*,  surgery*
Comment In:
J Obstet Gynaecol Res. 2011 Jun;37(6):670   [PMID:  21535313 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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