Spontaneous Uterine Rupture at Non-Cesarean Section Scar Site with Placenta Percreta in the Second Trimester: A Case Report(cid:31)
Komsun Suwannarurk MD*, Densak Pongrojpaw MD*, Sakol Manusook MD*, Worapop Suthiwartnarueput MD**, Kornkarn Bhamarapravatana PhD***
Affiliation : (cid:31) The abstract of this manuscript was presented on November 8-11, 2012 as poster presentation at the 17th World Congress on Controversies in Obstetrics, Gynaecology & Infertility (COGI 2012), Lisbon, Portugal * Department of Obstetrics & Gynaecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Department of Pathology & Forensic Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand *** Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Background : Uterine rupture was a common occurrence at previously cesarean-sectioned scar. Early sign of uterine rupture
was a severe fetal bradycardia.
Case Report : A 30-year-old, 3 gravida, 1 para woman was presented with an acute abdominal pain and hypovolemic shock.
Her gestational age was estimated at 18 weeks by emergency pelvic ultrasound. She had a lower segment scar from a
previous caesarean section. Initially, alive intrauterine pregnancy with massive hemoperitoneum was a provisional diagnosis.
During exploratory laparotomy, a ruptured of the right uterine fundus was found with placenta percreta. Hysterectomy was
performed. Fetal weight was 450 grams, APGAR score 0, 0 and the fetus could not survive. The patient was discharged on
the 4th day after surgery in healthy condition.
Conclusion : Uterine rupture is a catastrophic situation. Severe fetal bradycardia might be an early sign. This case demonstrates
the importance of clinical judgment based on clinical acumen.
Keywords : Uterine rupture, Placenta percreata, Non-scar site
