Placenta percreta at first trimester of pregnancy. Diagnostic and decision-making difficulties: about a case and a review of the literature

Abstract

We report the case of a 28-year-old patient, G9P4. Her last pregnancy was marked by a failure of a medical termination at 4 gestational weeks. She consulted as a matter of emergency for acute abdominal pain with moderated hemoperitoneum at 13 weeks of gestation. A laparotomy was performed and allowed to diagnose a placenta percreta (PPer). The treatment consisted in a hemostasis hysterectomy. The PPer is a rare pathology. The diagnosis is difficult to do, especially during the first and second trimester of the pregnancy. The focus of this article is to evaluate medical imaging and conservative treatments or radical treatment, according to the severity of the symptoms and her obstetrical outcome. This unusual etiology of hemoperitoneum at 13 weeks of gestation must to be known in front of the increase of the caesarians rate.