title: Conservative management of spontaneous uterine perforation associated with placenta accreta: a case report.
abstract: BACKGROUND
  Placenta accreta occurring in an unscarred uterus is exceedingly rare. Previous cases of spontaneous uterine perforation associated with placenta accreta were treated with hysterectomy.
  
  
  METHODS
  A nulliparous woman was clinically diagnosed with placenta accreta when spontaneous vaginal delivery was complicated by postpartum hemorrhage and a retained placenta. Magnetic resonance imaging subsequently revealed focal areas of placenta accreta. Acute-onset abdominal pain and cul-de-sac fluid prompted diagnostic laparoscopy, which revealed a spontaneous uterine perforation in the right posterior-lateral aspect of the uterus. This area was oversewn, and the patient received 2 weeks of postoperative antibiotics because of Enterococcus faecalis bacteremia.
  
  
  CONCLUSIONS
  Spontaneous uterine perforation associated with placenta accreta can be managed conservatively.
authors.affiliation: Division of Maternal/Fetal Medicine, Department of Obstetrics and Gynecology, National Naval Medical Center, Bethesda, Maryland 20889, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Gherman
authors.forename: Ernest G
authors.initials: EG
authors.lastname: Lockrow
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Flemming
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Satin
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D010921:Placenta Accreta / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D014597:Uterine Rupture / Q000150:complications / Q000175:diagnosis* / Q000601:surgery