There is little evidence for counseling patients who seek uterine conservation in the setting of placenta accreta.
We report the case of a 37-year-old woman with retained placenta accreta after vaginal delivery. Attempts at transvaginal removal failed, and the placenta was removed through a fundal hysterotomy with bilateral uterine artery ligations performed to control blood loss. She conceived a second pregnancy 11 months later and sustained spontaneous fundal uterine rupture at 26.5 weeks of gestation with a recurrent accreta found at the rupture site. The newborn survived but has residual musculoskeletal morbidity and developmental delay at 1 year of age.
Patients undergoing conservative treatment of placenta accreta in the setting of a fundal hysterotomy should be cautioned about recurrent accreta and uterine rupture.
Patients undergoing conservative accreta management with fundal hysterotomy should be counseled about uterine rupture.
Department of Obstetrics & Gynecology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
Corresponding author: Daniela A. Carusi, MD, MSc, Assistant Professor of Obstetrics and Gynecology, Harvard Medical School, Department of Obstetrics & Gynecology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail: firstname.lastname@example.org; email@example.com.
Financial Disclosure The authors did not report any potential conflicts of interest.