Second-trimester presentation of placenta percreta

Placenta percreta is diagnosed usually in the third trimester as massive po stpartum hemorrhage when an attempt to remove the placenta reveals lack of a cleavage plane. However, placenta percreta may present in the second trim ester with signs and symptoms of uterine rupture. The diagnosis of this eve nt may be difficult because of mild abdominal discomfort often associated w ith normal pregnancy. We describe two cases that occurred in the second tri mester with an unusual presentation. Both patients suffered considerable su rgical morbidity. Other cases reported in the literature are mentioned as w ell. When a patient with risk factors for abnormal placentation presents wi th abdominal pain and/or vaginal bleeding in the second trimester of pregna ncy, the diagnosis of placenta percreta should be considered. A laparotomy is indicated immediately when hemoperitoneum is suspected because uterine r upture has most likely occurred. Placenta percreta in the second trimester is a potentially life-threatening condition that warrants expeditious diagn osis to limit maternal postoperative morbidity.