Ruptur Uterus Spontan pada Plasenta Akreta: Tantangan dalam Diagnosis dan Manajemen Respon Cepat

Abstract

Background: Placenta accreta spectrum (PAS) is an abnormal placenta invasion through the endometrium that can cause mortality and morbidity in pregnant women. Spontaneous uterine rupture is one of the complications of PAS.

Case report: A 33-year-old woman was brought to the emergency department with a history of previous unconsciousness. The patient was a G3P2A0 28-29 weeks pregnant with suspected PAS. The primary survey examination found the patient in shock with GCS 15, BP 70/40 mmHg, N 123x/minute, RR 24x/minute, T 36.7oC, and SpO2 96% room air. Complaints of abdominal pain were recognized (NRS 8). Laboratory results found a decrease in hemoglobin value from 11.6 g/dL to 8.6 g/dL from the examination 1 day earlier. An emergency exploratory laparotomy was performed, and a total hysterectomy was decided. The patient was declared dead after 10 hours of treatment in the Intensive Care Unit (ICU).

Discussion: Spontaneous uterine rupture in PAS cases can occur even in patients who have not entered the labor phase. This condition is an obstetric emergency characterized by intra-abdominal bleeding that can cause shock, DIC, the possibility of hysterectomy, and other additional procedures to maternal and fetal death. The history of the patient's second delivery by cesarean section is believed to be a risk factor for PAS.

Conclusion: PAS is a challenging obstetric condition that requires comprehensive management to avoid maternal morbidity and mortality. Early detection, diagnosis, and appropriate multidisciplinary management can improve the success rate of PAS cases.