Obstetrics & Gynecology

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Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182926a42
Case Report

Uterine Rupture After Prior Conservative Management of Placenta Accreta

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

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Abstract

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.

© 2013 by The American College of Obstetricians and Gynecologists.

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