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      Placenta Accreta Causing Uterine Rupture in Second Trimester of Pregnancy after in vitro Fertilization: A Case Report

      Journal of Reproduction & Infertility
      Avicenna Research Institute
      ivf, placenta accreta, second trimester pregnancy, uterine rupture

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          Abstract

          Background

          Placenta accreta is a rare obstetrical condition that mainly occurs in the third trimester leading to life-threatening complications. Hereby, a case of uterine rupture due to placenta accreta occuring in the second trimester is presented.

          Case Presentation

          A forty-year old patient who conceived after in vitro fertilization treatment (oocyte donation and embryo transfer) presented in emergency department in the nineteen weeks of gestation with acute abdominal pain, heamoperitoneum and fetal death. Emergency laprotomy showed uterine rupture along with placenta accreta for which the patient underwent subtotal hysterectomy.

          Conclusion

          Although, an uncommon occurrence, physicians in assisted reproductive techniques (ART) clinics should consider placenta accreta in gravid patients who present with acute abdominal pain and shock, considering the fact that they usually have associated high risk factors for abnormal placentation.

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          Most cited references7

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          The pathology of placenta accreta, a worldwide epidemic.

          T Khong (2008)
          The incidence of placenta accreta, defined as the abnormal adherence of the placenta to the uterine wall, has been increasing alarmingly in the developed as well as the developing world. There is considerable maternal morbidity and mortality related to the condition. The pathophysiology focuses on the balance between decidualisation on the one hand and trophoblast invasion on the other. Pathological diagnosis relies on the finding of placental villi in direct apposition to myometrium, either in hysterectomy specimens or in placental basal plates.
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            Placenta percreta with spontaneous rupture of an unscarred uterus in the second trimester.

            Rupture of a pregnant uterus occurs most often in a scarred uterus, and spontaneous rupture of a non-scarred uterus in the early second trimester is rare. A woman with two previous normal vaginal deliveries and no prior trauma to the uterus presented at 16 weeks' gestation with an acute abdomen due to intraperitoneal hemorrhage. A large rupture of the fundus of the uterus was found. A supracervical hysterectomy was carried out, with subsequent good recovery. The specimen showed placenta percreta. Spontaneous rupture of an unscarred uterus, due to placenta percreta, should be considered in cases of acute intraperitoneal hemorrhage, even in early pregnancy.
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              Placenta accreta is associated with elevated maternal serum alpha-fetoprotein.

              To determine whether placenta accreta/percreta/increta is associated with elevation of second-trimester maternal serum alpha-fetoprotein (MSAFP) levels.
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                Author and article information

                Journal
                J Reprod Infertil
                J Reprod Infertil
                JRI
                Journal of Reproduction & Infertility
                Avicenna Research Institute
                2228-5482
                2251-676X
                Jan-Mar 2012
                : 13
                : 1
                : 61-63
                Affiliations
                [1 ]Akanksha IVF Center, Mata Chanan Devi Hospital, Janak Puri, New Delhi, India
                [2 ]Department of General Surgery, Mata Chanan Devi Hospital, Janak Puri, New Delhi, India
                [3 ]Department of Biochemistry, Pt. B. D. Sharma Post Graduale Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India
                Author notes
                [* ] Corresponding Author: Kiran Dahiya, 778/28, Bharat Colony, Rohtak, Haryana, India. E-mail: kirandahiya_2002@ 123456yahoo.com
                Article
                JRI-13-61
                3719369
                23926525
                8f4e89de-1b1d-4578-a8a6-3f9eaf2043e8
                Copyright © 2012 Avicenna Research Institute

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 18 May 2011
                : 26 September 2011
                Categories
                Case Report

                ivf,placenta accreta,second trimester pregnancy,uterine rupture

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