• Female
• Humans
• Hysteroscopy
• Placenta
• Placenta Accreta/surgery
• Pregnancy
• Retrospective Studies
• Uterine Diseases

Placenta percreta causing uterine rupture is a rare complication of pregnancy. It is most commonly diagnosed after the second trimester and can lead to significant morbidity necessitating abdominal hysterectomy of a gravid or immediately postpartum uterus. We describe a patient who presented with abdominal pain at 13 weeks of gestation and was diagnosed with placenta percreta during laparoscopy for presumed appendicitis. Intraoperatively, placenta was seen perforating the uterine fundus and 1 l of hemoperitoneum was evacuated. However, the uterus was hemostatic and the patient was stable, so the procedure was terminated. The patient was then transferred to a tertiary care center, where she ultimately underwent an uncomplicated laparoscopic gravid hysterectomy. We conclude that placenta percreta can occur in the first trimester even in patients without traditional risk factors. In stable patients, it is appropriate to consider minimally invasive hysterectomy with utilization of specific techniques to minimize intraoperative blood loss.

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Uterine rupture due to placenta percreta can present in the first trimester.

• First trimester
• Laparoscopic hysterectomy
• Placenta percreta
• Uterine rupture

• cesarean hysterectomy
• invasive placenta
• placenta accreta
• robotic surgery

Retained placenta is a known cause of post-partum haemorrhage and maternal mortality. A recent systemic review has confirmed that the incidence of retained placenta had increased all over the world, which is more common in developed countries. Failure of retro-placental myometrium contraction is the main cause of retained placenta. Maternal age greater than 35 years, grandmultipara, preterm labor, history of previous retained placenta, and caesarean section were the risk factors for retained placenta. Manual removal of the placenta has been the treatment of choice. Attempts had been made by clinician and researchers to find a safe, effective and reliable method to avoid the need for surgical intervention. The efficacy and safety of prostaglandin, nitroglycerin or acupuncture in the management of retained placenta are yet to be further evaluated. Nonetheless, till date only intra-umbilical vein oxytocin has been studied extensively but with varied success. More randomized clinical trials are needed to address this issue. However, if immediate manual placenta removal service is unavailable, a trial of intra-umbilical vein oxytocin 100 IU at a total volume of at least 40 mL while preparing for transfer to a tertiary center or theatre may result in spontaneous expulsion of the placenta.

• Retained placenta
• Manual removal of the placenta
• Intra-umbilical vein
• Oxytocin
• Prostaglandin
• Misoprostol
• Carboprost
• Acupuncture

• Emergency hysterectomy
• Laparoscopy
• Peripartum hysterectomy
• Subtotal hysterectomy
• Transcervical extraction

• Adult
• Emergencies
• Female
• Humans
• Hysterectomy/methods
• Laparoscopy
• Peripartum Period
• Placenta Accreta/surgery
• Placenta, Retained/surgery
• Pregnancy
• Retrospective Studies