Ezenwaez MN1*, Nweze SO1, Odugu BU1, Onah LN1, Mba SG1, Ortuanya KE1, Nevo C1, Ezenwaeze CN2, Chukwubuike OC1, Nneji CE1
1Department of Obstetrics and Gynecology, Enugu State University of Science Technology, College of Medicine, Nigeria 2Department of Pediatrics, University of Nigeria Teaching Hospital, NigeriaFulltext PDF
Introduction: Placenta percreta is a component and most invasive form of Placenta Accreta Spectrum (PAS) with high risk of maternal and perinatal morbidity and mortality.
Case Report: We present a rare case of silent uterine rupture due to placenta percreta at 32 weeks’ gestation in an unscarred uterus that harbored twin gestation. Patient was a 32-year-old P1+0A2 at 32 weeks gestation with complaints of abdominal pain and dysuria. Urgent abdominopelvic ultrasound revealed presence of two viable fetuses with estimated fetal weights of 1.7 and 1.6 for T1 and T2 respectively. The placenta was in anterior mid-uterine and presence of echo rich fluid in the peritoneum was noted. She had an emergency exploratory laparotomy, about 200 ml of Hemoperitoneum was observed and two live male fetuses delivered; the leading twin was in cephalic presentation, weighed 1.7 kg with APGAR scores of 7 in the 1st and 9 in the 5th minutes. The second twin was in breech presentation, weighed 1.6 kg with APGAR scores of 7 in the 1st and 10 in the 5th minutes. They had monochorionic and diamniotic placenta that situated at the anterior mid-uterine area, invaded and perforated through the myometrial wall onto the serosa, aborting on the anterior abdominal wall and bleeding. The neonates were nursed in neonatal intensive care unit for 3 weeks and discharged in good health condition. The patient had conservative management (placenta tissue was removed as much as possible, ruptured site sutured and methotrexate administered to the patient). Conclusion: The morbidity and mortality associated with uterine rupture due to placenta percreta calls for meticulous and systematic search for clinical and ultrasound evidence of PAS during antenatal and routine antenatal ultrasonography respectively, in addition to prompt surgical intervention in at risk patients to avert possible catastrophe that may occur.
Placenta percreta; Uterine rupture; Twin gestation
Ezenwaeze MN, Department of Obstetrics and Gynecology, Enugu State University of Science Technology, College of Medicine, Enugu State, Nigeria.