Late pregnancy uterine perforation caused by penetrating placenta accreta in 1 case.docVIP

 PAGE \* MERGEFORMAT 5 Late pregnancy uterine perforation caused by penetrating placenta accreta in 1 case [Keywords:] placenta accreta, uterine perforation 1 Case Report Patients 23 years old, G2P0, 35 +5 weeks due to menopause, abdominal pain, dizziness, weakness 1 hour, transferred from a community hospital in our hospital. Physical examination: pulse 120 beats / min, breathing 30 times / min, blood pressure 80/50mmHg, pale , showed a severe anemia appearance, conscious, lazy words, abdominal bulge, liver and spleen palpation are not satisfied, abdominal plate, full of tenderness. obstetric cases: Temple High 33cm, abdominal circumference 98cm, fetal position is unclear, no fetal heart rate, fetal movement and vaginal examination: cervix is #8203;#8203;not open, the first outcrop of emergency bedside .. B-TIP: do not test and fetal heart rate, pregnant women, a large number of intra-abdominal fluid. blood Tip: hemoglobin 66g / L. consider intra-abdominal hemorrhage, and immediately the line laparotomy duct exploration. intraoperative peritoneal see was purple and blue, opened a large number of bloody peritoneal fluid that is poured out, see the normal color of the lower uterine segment, the formation of poor exploration no double annex bleeding, uterine lower segment cesarean section. parturition of a dead baby boy After narrowing the uterus, see Palace of uterine wall near the left corner there is a break, diameter of about 4cm, active bleeding, placenta accreta break at the see, through full-thickness uterine wall, break the surrounding myometrial thinning , scar formation, rupture and left isthmus near the old suture visible. the right end of adhesions in the uterine tube at the bottom of the umbrella. intraoperative immediately confessed to the family illness, requiring subtotal hysterectomy. intraoperative blood and clean-up clot of about 3500ml, through smoothly discharged after 10 days. 2 Discussion Department of villi of placenta ac