title: Nearly fatal uterine rupture during manual removal of the placenta: a case report.
abstract: BACKGROUND
  A uterine scar is a well-known riskfactorfor both abnormal placentation and uterine rupture, both of which may lead to a serious obstetric hemorrhage.
  
  
  METHODS
  A 23-year-old woman, gravida 2, para 0 with a history of first-trimester dilatation and curettage (D&C) experienced a life-threatening obstetric hemorrhage due to uterine rupture during manual removal of a placenta increta. Cessation of the bleeding occurred only following secondary embolization after hysterectomy.
  
  
  CONCLUSIONS
  Obstetricians should be aware of the risk of uterine scarring and abnormal placentation in women who have undergone D&C, as it could lead to a life-threatening obstetric hemorrhage.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. j.j.zwart@lumc.nl
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Zwart
authors.forename: Hans C M
authors.initials: HC
authors.lastname: van Huisseling
authors.forename: Herman M
authors.initials: HM
authors.lastname: Schuttevaer
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D000328:Adult; D000792:Angiography; D002921:Cicatrix / Q000150:complications*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004107:Dilatation and Curettage / Q000009:adverse effects*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010921:Placenta Accreta; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000628:therapy*; D011247:Pregnancy; D012307:Risk Factors; D014597:Uterine Rupture / Q000209:etiology* / Q000601:surgery