Rotura uterina durante el segundo trimestre de gestación asociado a placenta percreta: presentación de un caso y revisión de la literature

Abstract

Objective: To report the management of a case of uterine rupture associated with placental percreta in the second trimester of pregnancy, and to make a review of the literature about the diagnosis and treatment of this condition. Presentation of the Case: A 31-year-old patient with intraoperative diagnosis of uterine rupture associated with placental percretism at week 21 of gestation, who required immediate surgical intervention for acute abdomen, which developed in a hypovolemic shock and fetal death in utero. Materials and methods: A Research was done of the literature registered in the databases between 1995 and 2017, and published in English and Spanish. We included case reports and case series and review articles, in relation to prenatal diagnosis and treatment. Results: The majority of reported cases of uterine rupture that are found in women with this condition are due to percretism between week 9 and 34 of gestation. The treatment is surgical in the great number of cases, which procedure will follow depending on the intraoperative findings and associated medical conditions. Conclusion: Placental accreta presented at early stages of gestation is rare, however it should be taken into account while considering the clinical and paraclinical findings. The treatment must be directed accordingly to the degree of placental invasion and hemodynamic situation, although most of the time will lead to surgery performed by an interdisciplinary team.