SPONTANEOUS RUPTURE OF A PRIMIGRAVID UTERUS SECONDARY TO PLACENTA PERCRETA - A CASE-REPORT

BACKGROUND: Uterine rupture secondary to placenta percreta has been ob served in multiparous patients. These cases are typically associated w ith a prior history of uterine trauma or infection: hysterotomy, myome ctomy, control resection, dilatation and curettage, manual removal of the placenta or endometritis. Spontaneous rupture of the primigravid u terus without a history of trauma or infection is an exceedingly rare occurrence. This case represents the second reported in the medical li terature and the first to result in a live-born infant. CASE: A 23-yea r-old, African American primigravida at 26 weeks' gestation presented with acute-onset abdominal pain, severe hypotension, tachycardia and f etal heart rate decelerations. Blood product replacement teas initiate d, and an emergency laparotomy was performed for a presumptive diagnos is of intraabdominal hemorrhage. A significant hemoperitoneum was enco untered, with the fetus floating freely in the peritoneal cavity. The uterus had a fundal rupture with a clinically apparent placenta percre ta that necessitated performing a total abdominal hysterectomy. The pa tient recovered uneventfully, and the infant survived without signific ant morbidity. CONCLUSION: Spontaneous rupture of the primigravid uter us can occur in the absence of a history of uterine trauma or infectio n. Ifa gravid woman presents with hypotension, abdominal pain and feta l distress, the differential diagnosis should include rupture of the u terus, regardless of purity or gynecologic history. Rapid diagnosis, b lood product replacement and emergency laparotomy are the key steps in successful management.