Spontaneous Uterine Rupture At The 18th Week Of Gestation Due To Placenta Percreta: A Case Report

Spontaneous uterine rupture (SUR) is a very rare but life-threatening pregnancy complication, and it generally has an un-derlying cause. Scarred uteri because of any reason such as cesarean delivery, dilatation and curettage, myomectomy, etc. is a risk factor for SUR and also for placenta percreta which is a placental adhesion abnormality and another risk factor for SUR. In this case, a 35-year-old woman at 18 weeks of pregnancy was admitted to our emergency service with new onset nausea, vomiting, weakness and abdominal pain. She had two cesarean deliveries before and there is no other medical history. Her vital signs were within normal range. On physical examination, there was tenderness in all quadrants of abdomen but no guarding, rebound or vaginal bleeding, tenderness or cervical dilation. While waiting for blood and urinalysis test results, she fainted due to orthostatic hypotension when she stood up. After syncope her blood pressure was recorded as 80/50 mm Hg and intravenous crystalloid fluid replacement was started. Test results showed a decrease in hemoglobin value and on abdominal ultrasound there was widespread free fluid in abdomen, and a suspicious defec-tive area was observed which possibly connecting the intraperitoneal fluid with the amniotic fluid. Uterine rupture and intraabdominal bleeding were suspected, and she was taken to emergency surgery with a general surgeon and a gynecol-ogist. Histopathology confirmed rupture occurred on the placenta percreta background. This case highlights the need to consider SUR even in early gestational weeks, especially in scarred uteri.