Placenta Percreta Complicated by a Silent Uterine Rupture and Postpartum Haemorrhage: A First Experience at a Teaching Hospital in Southwest Nigeria

Placenta percreta, the most severe form of placenta accreta spectrum (PAS) disorder, is a life-threatening obstetric condition characterized by abnormal placental invasion into the uterine wall. Silent uterine rupture, without classical signs, complicates diagnosis and management. This report documents the first known case of placenta percreta with silent uterine rupture and postpartum hemorrhage (PPH) at Ekiti State University Teaching Hospital, Nigeria. A 48-year-old primigravida with a prior myomectomy conceived through in vitro fertilization (IVF) and underwent elective Caesarean delivery at 38 weeks. Intraoperatively, placenta percreta with complete myometrial invasion was identified, leading to silent uterine rupture. A hysterectomy was performed to control hemorrhage. The patient delivered a live neonate weighing 3.32 kg with APGAR scores of 5 and 8. Despite blood loss of 1200 mL, she remained stable without transfusion and recovered uneventfully. This case highlights the importance of antenatal surveillance in high-risk pregnancies and the need for early recognition of PAS. The successful management underscores the role of a multidisciplinary approach. Improved diagnostic strategies and institutional preparedness are essential for optimizing maternal outcomes in resource-limited settings.