Placenta increta causing uterine rupture during the second trimester of pregnancy in a 30-year-old pregnant female: A rare case report.

INTRODUCTION AND IMPORTANCE

Placenta accreta spectrum is a life-threatening obstetrical condition that can cause uterine rupture and needs to be diagnosed and managed quickly to avoid catastrophic outcomes. Uterine rupture is characterized by the separation of all three uterine layers: endometrium, myometrium, and perimetrium. This potentially fatal disorder often arises in the third trimester of pregnancy and is rarely detected in the first or second trimesters.

CASE PRESENTATION

A 30-year-old pregnant female Gravida 3 para 2 (G3P2) presented in the emergency department with signs of shock at 22 weeks gestation due to a previously scarred uterus by a cesarean delivery. She had acute abdominal pain, massive hemoperitoneum, and a living fetus with bradycardia. No vaginal bleeding was detected. Emergency laparotomy showed uterine rupture at the site of the previous lower uterine segment cesarean section (LSCS) along with an abnormally invasive placenta into the myometrium (placenta increta) for which the patient underwent total hysterectomy.

CLINICAL DISCUSSION

This case report presents a complex instance of spontaneous uterine rupture in a pregnant patient during the second trimester with accompanying central placenta previa and placenta increta, emphasizing the challenges and clinical implications of managing such a high-risk condition.

CONCLUSION

Uterine rupture should always be considered a differential diagnosis for abdominal pain at any trimester, and can cause hypovolemic shock even in the absence of vaginal bleeding, especially when associated with abnormal placentation. Quick diagnosis, management and intervention improves survival rate and decreases maternal and fetal morbidity.