Résumé

Background: Placenta percreta is a rare but severe form of placenta accreta spectrum, usually associated with previous uterine surgery. Its occurrence in a normally implanted placenta on an otherwise unscarred uterus is exceptional and may present with life-threatening complications. Clinical case: We report the case of a 37-year-old woman in her sixth pregnancy, with four living children, all delivered vaginally. Her history included a miscarriage managed by uncomplicated haemostatic curettage. At 30 weeks of gestation, while receiving treatment for gestational hypertension, she was admitted in shock with acute, severe abdominopelvic pain. Ultrasonography showed massive haemoperitoneum, intrauterine fetal death, a fundal placenta and loss of uterine wall continuity in the cornual fundal region. Emergency laparotomy revealed placenta percreta with right cornual uterine perforation. Caesarean delivery followed by haemostatic hysterectomy was performed. Outcome: Despite intensive resuscitation and massive transfusion, the patient died intraoperatively. Conclusion: This case illustrates the catastrophic potential of placenta percreta even in the absence of a major uterine scar and highlights the difficulty and importance of early antenatal diagnosis and appropriate multidisciplinary management.

Mot-clés :

Placenta Percreta; Uterine Perforation; Hysterectomy; Maternal Mortality