Laužikienė Dalia, Vosylius Saulius, Šiaudinytė Ieva, Laužikas Emilis, Ramašauskaitė Diana, Bartkevičienė Daiva
Department of Obstetrics and Gynaecology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University Vilnius, Lithuania.
Acta Med Litu. 2018;25(2):61-65. doi: 10.6001/actamedica.v25i2.3758.
Uterine rupture at the site of a previous caesarean scar with abnormal placental penetration through the uterus wall with bladder invasion is a rare and serious pregnancy complication. Our aim was to report a case of uterine rupture with placenta percreta complicated by thrombotic microangiopathy.
We did a literature review and analysed medical documentation retrospectively.
A patient was admitted with complaints of lower abdominal pain at 21 weeks of gestation. Sonography of the caesarean scar increased suspicion of placental penetration. Anaemia, thrombocytopenia, coagulopathy, and acute kidney injury developed and led to the diagnosis of thrombotic microangiopathy. The termination of pregnancy was required due to severe deterioration in organ functions. The complete uterine rupture with placenta percreta invading the urinary bladder was confirmed, and total hysterectomy was performed to control life-threatening haemorrhage. The patient was treated by blood component transfusions, renal replacement therapy, and plasmapheresis. Good health was confirmed two months later by laboratory and instrumental tests.
It is a rare but very serious condition that increases morbidity of mother and foetus, therefore immediate diagnostics and treatment are required.
既往剖宫产瘢痕部位子宫破裂，胎盘异常穿透子宫壁并侵犯膀胱，是一种罕见且严重的妊娠并发症。我们的目的是报告一例子宫破裂合并胎盘植入并发血栓性微血管病的病例。
我们进行了文献综述并回顾性分析了医疗记录。
一名患者在妊娠21周时因下腹部疼痛入院。剖宫产瘢痕的超声检查增加了胎盘穿透的怀疑。出现贫血、血小板减少、凝血病和急性肾损伤，导致血栓性微血管病的诊断。由于器官功能严重恶化，需要终止妊娠。证实为完全性子宫破裂，胎盘植入侵犯膀胱，行全子宫切除术以控制危及生命的出血。患者接受了成分输血、肾脏替代治疗和血浆置换治疗。两个月后通过实验室和仪器检查确认健康状况良好。
这是一种罕见但非常严重的情况，会增加母婴发病率，因此需要立即进行诊断和治疗。
