http://dx.doi.org/10.5455/2320-1770.ijrcog20131249 Volume 2 · Issue 4 Page 714 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Samal S et al. Int J Reprod Contracept Obstet Gynecol. 2013 Dec;2(4):714-716 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Placenta percreta induced uterine rupture at 15 weeks of gestation: an unusual case Sunita Samal * , Seetesh Ghose, P. Pallavee, Ramya Thulasi INTRODUCTION Placenta accreta is an abnormal deep attachment of placenta to the myometrium which is of two types: placenta increta and percreta. Placenta percreta is the rarest and most severe form. This is due to partial or total absence of decidua basalis, imperfect development of Nitabuch layer and firm adherence of placenta to uterine myometrium. 1 In placenta accreta chorionic villi grow into the basal decidua, in increta it penetrate into the musculature and in placenta percreta the villi not only pass through the myometrium and serosa, but also penetrate adjacent structures like bladder and bowel resulting in catastrophic haemorrhage. Literature review shows spontaneous uterine rupture due to placenta percreta is rare and usually occurs in late second and third trimester. But its occurrence, resulting in life threatening situation, in first and early 2 nd trimester is very rare. Here we are reporting a case of a pregnant woman, who presented to us in haemorrhagic shock at 15wks of gestation due to placenta percreta induced uterine rupture. CASE REPORT A 27 years old pregnant woman (gravida 2, para 1) at 15 weeks of gestation with history of previous caesarean section was admitted to emergency department with breathlessness and pain abdomen for 6hours. On clinical examination she was in early hypovolemic shock with abdominal distension. Ultrasonography revealed gross fluid collection in peritoneal cavity with intrauterine 15wks anomalous foetus and a low-lying placenta. Paracentesis was done to know the nature of fluid, which was positive for blood. A diagnosis of rupture uterus was made and planned for emergency laparotomy along with simultaneous resuscitation of the patient. On laparotomy there was haemoperitoneum of about 3litres, with 1-2cm of rent at left anterior surface near isthmus through which Department of Obstetrics & Gynecology, Mahatma Gandhi Medical College & Research Institute, Pilliyarkuppam, Puducherry, India Received: 27 September 2013 Accepted: 8 October 2013 *Correspondence: Dr. Sunita Samal, E-mail: sunisamal@rediffmail.com © 2013 Samal S et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Spontaneous rupture of uterus during early pregnancy due to placenta percreta is a rare complication, which is potentially life-threatening to both mother & fetus and also difficult to diagnose. A 27 years old pregnant woman with history of previous one caesarean section 2 years back was referred to our emergency department with severe anaemia and breathlessness. On examination patient was in hypovolemic shock. Ultrasonography revealed massive fluid collection in peritoneal cavity, an intrauterine anomalous foetus of 15 weeks and low-lying placenta. Paracentesis was positive for blood. On laparotomy there was haemoperitoneum of about 3 litres with placenta perforating through the lower segment of uterus. Even after all measures to conserve uterus, due to uncontrolled bleeding hysterectomy was performed. Postoperative period was uneventful. Pathological analysis of the specimen confirmed our diagnosis of placenta percreta. Though uterine rupture is rare in early trimester, it may be considered in a patient with haemoperitoneum with a scarred uterus, which can be due to placenta percreta also. Keywords: Haemoperitoneum, Hysterectomy, Placenta percreta DOI: 10.5455/2320-1770.ijrcog20131249