RESUMO
Placenta percreta is a complication of pregnancy with significant morbidity and mortality rates. Spontaneous uterine rupture in early pregnancy due to placenta percreta is rare. We report a case of this life- threatening complication occurring at sixteenth week of gestation. The patient presented with signs of shock, acute abdomen, and evidence of hemoperitoneum. The pregnancy was viable with a normal ultrasound appearance that created some confusion and there was a dilemma in the diagnosis of this case. Various obstetric and surgical causes were taken into consideration. The patient was taken to the operating room immediately for exploratory laparotomy. She was found to have fundal uterine rupture, which was managed by uterine repair. This patient had prior cesarean section and dilatation and curettage; factors well known to predispose for placenta percreta. Here, we emphasize the importance of a fast decision and surgical intervention to save a patient's life in cases of uterine rupture
RESUMO
The coexistence of intrauterine and ectopic pregnancy [heterotopic pregnancy] occurs in 1/30,000 of spontaneous pregnancies, 1/900 in Clomiphene citrate induced pregnancies and rises to 1% in assisted reproduction. It is a life-threatening condition with diagnostic and therapeutic complexities. There is strong association between infertility and ectopic pregnancy. Risk factors for ectopic pregnancy are past history, assisted reproduction, and adhesions due to pelvic infection or surgery. Our patient was diagnosed initially as having an intrauterine singleton pregnancy, with urinary tract infection. At presentation pain out of proportion to primary diagnosis led to urgent ultrasonographic review that diagnosed heterotopic pregnancy. It was followed by laparoscopic salpingectomy. Human chorionic gonadotrophin [HCG] after laparoscopy in the subsequent days along with a sonographic evaluation revealed a viable intrauterine pregnancy. This ended in missed miscarriage and medical expulsion at 16 weeks of gestation. Issues discussed here are rarity, delayed, or misdiagnosis with its sequel