title: Spontaneous uterine rupture at the 21st week of gestation caused by placenta percreta.
abstract: OBJECTIVE
  To describe the management of a ruptured uterus caused by placenta percreta in the 21st week of gestation.
  
  
  METHODS
  We present a case report of a 33-year-old patient with a ruptured uterus in the 21st week of gestation who presented at the Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Luebeck. Therapeutic management was performed by laparoscopy, and consecutive laparotomy and hysterectomy.
  
  
  RESULTS
  A 33-year-old patient presented with severe abdominal pain in the 21st week of gestation at the department of abdominal surgery. A laparoscopy was performed to exclude appendicitis. There was about one liter of blood in the peritoneal cavity and a small, bleeding lesion in the fundus uteri was found which was coagulated. The blood was evacuated and the patient returned to department of gynecology. One hour after the first operation, the patient developed signs of hypovolemic shock and ultrasound showed absent fetal heart beat. An immediate laparotomy was performed and a ruptured uterus was detected. The fetus was removed and a hysterectomy performed. Pathology results showed a placenta percreta. After a few days in hospital and transfusion of 4 liters of blood the patient was discharged in a healthy condition.
  
  
  CONCLUSIONS
  In a pregnant woman with severe abdominal pain even in the 21st week of gestation a placenta percreta has to be considered as a differential diagnosis. If there is no evidence of other causes, laparoscopy may help to confirm the diagnosis and hysterectomy is a life saving intervention.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Amadeus
authors.initials: A
authors.lastname: Hornemann
authors.forename: Michael K
authors.initials: MK
authors.lastname: Bohlmann
authors.forename: Klaus
authors.initials: K
authors.lastname: Diedrich
authors.forename: Andreas
authors.initials: A
authors.lastname: Kavallaris
authors.forename: Sven
authors.initials: S
authors.lastname: Kehl
authors.forename: Katharina
authors.initials: K
authors.lastname: Kelling
authors.forename: Friederike
authors.initials: F
authors.lastname: Hoellen
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003937:Diagnosis, Differential; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D010921:Placenta Accreta / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis; D012422:Rupture, Spontaneous; D014597:Uterine Rupture / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*