Placenta Induced Third Trimester Uterine Rupture in an Unscarred Uterus: A Diagnostic Dilemma

ABSTRACT: Cases of urine rupture induced by a percreta in an unscarred uterus are rare. This is a case of 30 year old, Gravida 2 Para 1 (1001) Pregnancy Uterine 31 Weeks and 2 days age of gestation with persistent generalized abdominal pain found out to have uterine rupture secondary to placenta percreta. This paper aims to discuss the differential diagnoses foe cases of third trimester abdominal pain, the appropriate diagnostic modalities and the best management for such case. Uterine rupture should be considered in the differential diagnosis in all pregnant women who present with acute abdomen even if there are no risk factors. Exploratory laparotomy was done to investigate the cause of the patient's severe abdominal pain on top of intrauterine fetal bradycardia. During the procedure, uterine rupture with massive bleeding was detected; therefore, subtotal abdominal hysterectomy was performed was discharged without any complications. Pathological analysis of the uterine sspecimen revealed placenta percreta to be the cause of the rupture. In conclusion, uterine rupture should be considered in the differential diagnosis in all pregnant women who present with acute abdomen even if there are no risk factors. Several diagnostic modalities such as ultrasonography and MRI can be helpful in the diagnosis but high index of suspicion and clinical judgment are still if higher value and histopathology in the gold standard for making the final diagnosis of Placenta Percreta. The choice between Hysterectomy or conservative therapy is dependent on the severity of the placenta percreta. Conservative management has a 4-fold increase in mortality rate compared with hysterectomy hence in emergency cases hysterectomy is preferred.

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