Katti Fatima, Sara Heba, Katti Zeinab, Elias Sabrina, Marzouk Zeina Zakarya, Adwan Dema
University Hospital of Obstetrics and Gynecology, Damascus, Syria.
University Hospital of Obstetrics and Gynecology, Damascus, Syria.
Int J Surg Case Rep. 2025 Aug;133:111509. doi: 10.1016/j.ijscr.2025.111509. Epub 2025 Jun 19.
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.
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.
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.
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.
胎盘植入谱系疾病是一种危及生命的产科病症，可导致子宫破裂，需要迅速诊断和处理以避免灾难性后果。子宫破裂的特征是子宫的三层组织（子宫内膜、肌层和浆膜层）全部分离。这种潜在致命的病症通常发生在妊娠晚期，在妊娠早期或中期很少被检测到。
一名30岁的经产妇，孕3产2（G3P2），因既往剖宫产子宫有瘢痕，在妊娠22周时因休克征象就诊于急诊科。她有急性腹痛、大量腹腔内出血，且胎儿存活但心动过缓。未检测到阴道出血。急诊剖腹探查显示，在先前子宫下段剖宫产（LSCS）部位发生子宫破裂，同时胎盘异常侵入肌层（胎盘植入），患者因此接受了全子宫切除术。
本病例报告呈现了一名妊娠中期孕妇自发性子宫破裂并伴有中央性前置胎盘和胎盘植入的复杂病例，强调了处理这种高危病症的挑战和临床意义。
子宫破裂应始终被视为任何孕周腹痛的鉴别诊断，即使没有阴道出血也可导致低血容量性休克，尤其是与胎盘异常有关时。快速诊断、处理和干预可提高生存率并降低母婴发病率。
