Flissate Farah, Kassou Oumaima, Mahfoud Hounaida, Zeraidi Najia, Baidada Aziz
Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco.
Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco.
Int J Surg Case Rep. 2024 Dec;125:110411. doi: 10.1016/j.ijscr.2024.110411. Epub 2024 Oct 3.
Placenta accreta is characterized by the abnormal attachment of the placenta to the myometrium without the usual presence of decidua in between. In its percreta form, this attachment extends deeply into the myometrial wall, reaching the serosa and occasionally affecting nearby organs like the bladder and rectum. The advancement of these conditions often leads to hemorrhagic complications, significantly jeopardizing maternal well-being.
We present a case of placenta percreta presenting with hemorrhage and hemoperitoneum at 31 weeks' gestation due to a spontaneous uterine rupture. Swift action with a total hysterectomy for maternal rescues was performed, unfortunately the fetus was already dead on arrival.
Placenta accreta spectrum occurs when the placenta adheres abnormally to the myometrium and serosa rather than to the decidua. Spontaneous uterine rupture caused by placenta accreta is a rare and serious complication leading to hemorrhage and in sometimes unfortunately to mortality, as was the case in our patient. Antenatal diagnosis by ultrasound is recommended to avoid complications and improve management. Definitive diagnosis is made after pathological examination.
The incidence of placenta percreta has surged alongside the notable increase in cesarean section rates. While it remains rare, this condition presents a potentially fatal complication. Early antenatal diagnosis plays a crucial role in mitigating the risk of complications and maternal mortality.
胎盘植入的特征是胎盘异常附着于子宫肌层，其间缺乏正常的蜕膜组织。在穿透性胎盘植入形式中，这种附着深入子宫肌层壁，直达浆膜层，偶尔还会影响附近器官，如膀胱和直肠。这些情况的进展常常导致出血并发症，严重危及产妇健康。
我们报告一例妊娠31周时因自发性子宫破裂出现穿透性胎盘植入并伴有出血和腹腔积血的病例。为挽救产妇迅速实施了全子宫切除术，不幸的是，胎儿在送达时已经死亡。
当胎盘异常附着于子宫肌层和浆膜层而非蜕膜时，就会发生胎盘植入谱系疾病。由胎盘植入引起的自发性子宫破裂是一种罕见且严重的并发症，会导致出血，有时不幸会导致死亡，我们的患者就是如此。建议通过超声进行产前诊断，以避免并发症并改善管理。确诊需在病理检查后作出。
随着剖宫产率显著上升，穿透性胎盘植入的发生率也有所增加。虽然这种情况仍然罕见，但却是一种潜在的致命并发症。早期产前诊断在降低并发症风险和产妇死亡率方面起着至关重要的作用。
