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Surgical uterus-preserving therapy after uterine rupture and haemorrhage due to placenta percreta in the first trimester following embolisation of the uterine arteries and B-Lynch suture in a previous pregnancy
  1. Laura Gabriel,
  2. Louisa Ederhof,
  3. Ursula Fellmann and
  4. Gesine Meili
  1. Gynecology/Obstetrics, Kantonsspital Winterthur, Winterthur, Switzerland
  1. Correspondence to Dr Laura Gabriel; laura.gabriel{at}ksw.ch

Abstract

A woman in her early 30s in the 11 2/7 week of pregnancy was admitted with severe abdominal pain and emesis. One year prior, the patient had undergone hysteroscopic adhesiolysis to treat Asherman syndrome resulting from a prior pregnancy. Examination of the patient revealed a haemoperitoneum and an intact intrauterine pregnancy. Laparoscopic adhesiolysis and haemostasis was performed and the patient was transferred to the intensive care unit. Subsequent examination due to persistent abdominal pain revealed an occult iatrogenic perforation of the uterus and placenta percreta with spontaneous uterine rupture. Although treatment for placenta percreta has generally been hysterectomy, in this case, the rupture and perforation sites were resected, representing successful fertility preserving management for this oft-overlooked pregnancy complication.

  • Obstetrics and gynaecology
  • Pregnancy
  • Surgery
  • Emergency medicine
  • Ultrasonography

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Footnotes

  • Contributors LG: conception and design, analysis and interpretation of data, drafting the article, final approval. LE: analysis and interpretation of data, revising it critically for important intellectual content drafting the article, final approval. UF: acquisition, revising it critically for important intellectual content, final approval. GM: conception and design, acquisition, revising it critically for important intellectual content, final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.