article · Surgery Case Reports
Placenta percreta is a rare but known cause of spontaneous uterine rupture in late pregnancy, associated with exceedingly high maternal and fetal mortality. This case report describes a 44-year-old primiparous patient with a prior surgical history of myomectomy, who presented at 40 weeks' gestation with hemorrhagic shock due to a massive hemoperitoneum. Despite immediate initiation of aggressive fluid resuscitation, massive transfusion protocol, and an emergency peripartum hysterectomy performed for hemostasis, the patient developed irreversible hemorrhagic shock and sustained catastrophic anoxic brain injury, leading to death. This case demonstrates that a high index of suspicion for spontaneous uterine rupture from placenta percreta is mandatory in every at-risk patient. Clinical evaluation must include active investigation for hemoperitoneum, irrespective of the presence or absence of prenatally diagnosed morbidly adherent placenta. The speed of diagnosis and initiation of multidisciplinary intervention is the sole prognostic factor.
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DOI: 10.1016/j.sycrs.2026.100212
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