Early accreta and uterine rupture in the second trimester
This case, published in Cureus describes a case of a 38-year-old gravida 6 preterm 3 term 1 abortus 1 live 4 (G6P3114) at 23 weeks and five days gestational age (GA) with a past medical history of preterm pregnancy, pre-eclampsia, chronic abruptia, three previous c-sections, and low-lying placenta who presented to the emergency department (ED) with vaginal bleeding.

Initial workup revealed placenta accreta and possible percreta. The patient was placed on intramuscular (IM) corticosteroids in anticipation of preterm delivery. As soon as the patient was stable, she was discharged home. She presented to a different hospital the next day with the same complaints. Imaging was consistent with accreta and her presentation with abruption. During the hospital stay, the patient went into threatened preterm labor (PTL).

At first, a preterm premature rupture of membranes (PPROM) was suspected due to apparent pooling of amniotic fluid in the vaginal canal. Upon further work up, the diagnosis was consistent with chronic abruption oligohydramnios sequence (CAOS). Before this could be investigated, her hospital course was complicated by acute abruption and Category III/nonreassuring fetal heart rate (FHR) tracing.

The patient underwent an emergency c-section at 26 weeks GA as well as a planned supracervical hysterectomy for desired permanent sterilization. During the operation, the patient suffered a postpartum hemorrhage (PPH) of 4500 mL. She was later discharged home on postoperative day (POD) eight.

Read more here: https://pxmd.co/VD9Dx
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Dr. S●●●●●v S●●●●●1
Dr. S●●●●●v S●●●●●1 Obstetrics and Gynaecology
Either no counselling as such or legal constraints entire episode could have been avoided through voluntary sterilisation during the last CS. We are not less responsible for rampant proliferation of such cases by the way we repair caesarean incisions - the number of layers we like to stitch, the material we use, the amount of force we expert and the way we lock the stitches - you know all these matter. Such cases should be bare minimum in modern obstetric.... Read more
Nov 6, 2018Like1