Conservative Management of Placenta Percreta With Perforation in an Infertile Lupus Patient Following Embryo Transfer: A Report of a Rare Case

Placenta accreta spectrum (PAS) is a life-threatening condition characterized by abnormal placental invasion of the myometrium and is often associated with uterine surgery. However, it can also occur in unscarred uteri, particularly during pregnancies using assisted reproductive technology (ART). Following a successful pregnancy via vitrified-warmed embryo transfer, a 33-year-old nulliparous woman with systemic lupus erythematosus and long-term steroid use presented with intra-abdominal hemorrhage due to placenta percreta and spontaneous uterine perforation at week 10 of gestation. The patient was managed conservatively to preserve fertility. Over two years, the placenta spontaneously resorbed, and laparoscopic repair of an anatomical defect in the muscular layer of the perforation was successfully performed. Finally, the uterus returned to normal size. This case underscores the increased risk of PAS in ART pregnancies, particularly during hormone replacement therapy cycles and long-term oral steroid administration, and highlights the potential for conservative management and fertility preservation following PAS with uterine perforation.