Repair of Uterine Rupture With Placenta Accreta at 22 Weeks, Followed by Cesarean Hysterectomy Delivery of Healthy Neonate at 32 Weeks

Introduction Uterine rupture at previable gestational ages is almost always treated with evacuation of the pregnancy, followed by uterine repair or hysterectomy. Case Presentation A 40‐year‐old woman with one prior cesarean section presented at 22 weeks of gestation with an acute abdomen. Imaging noted hemoperitoneum with areas of bulging in the anterior uterine wall. Laparoscopy converted to a laparotomy through a midline incision, noted an actively bleeding 2 cm area of uterine rupture with protruding placental tissue. The uterine rupture was surgically closed with sutures. The patient was kept in the hospital for the remainder of her pregnancy. At 32 weeks, a planned cesarean hysterectomy was performed with delivery of a healthy baby. A supracervical hysterectomy was then performed without complication. The mother was discharged home on postoperative day 3. The pathology report noted placenta accreta. The baby was discharged in good health at 1 month of life. Discussion Our case demonstrates that repair of uterine rupture with a previable fetus, even in the presence of a placenta accreta, can lead to prolongation of the pregnancy and eventual delivery of a healthy baby.