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Uterine Rupture After Prior Conservative Management of Placenta Accreta

Deshpande, Neha A. BA; Carusi, Daniela A. MD, MSc

doi: 10.1097/AOG.0b013e3182926a42
Case Report

BACKGROUND: There is little evidence for counseling patients who seek uterine conservation in the setting of placenta accreta.

CASE: 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.

CONCLUSION: 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: dcarusi@partners.org; neha_deshpande@hms.harvard.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists.